儿童左束支传导阻滞43例病因及临床特点分析

Analysis of etiology and clinical features of left bundle branch block in 43 children

目的探讨儿童左束支传导阻滞(LBBB)的病因、临床特点及预后。方法回顾分析2013年1月到2018年12月诊断LBBB患儿的临床资料。结果LBBB患儿43例,男35例、女8例,中位年龄36(9~72)月。其中完全性LBBB 36例,左前分支阻滞7例;心脏增大36例,心功能减低16例。12例为先天性心脏病外科手术(7例为室间隔缺损修补术,5例为复杂先天性心脏病手术),12例室间隔缺损封堵术后,6例为心肌病,4例为心肌炎,4例先天性心脏病术前,3例为无器质性心脏病患儿颅脑外伤及溺水儿童各1例。12例患儿为室间隔缺损封堵术后第1~7日出现LBBB,给予激素、营养心肌等药物治疗后,8例术后早期均恢复,4例治疗后无好转在介入封堵术后第3~8日时取出封堵器及修补室间隔缺损后恢复正常。12例先天性心脏病外科术后出现LBBB,给予激素、营养心肌等药物治疗后,8例患儿恢复正常,3例逐渐进展为III度房室传导阻滞后均植入永久心脏起搏器,1例仍为LBBB;随访时间中位数24(12~49)月,随访结束时,1例室间隔缺损封堵术早期恢复正常随访7个月出现迟发性LBBB;1例复杂先天性心脏病术后仍LBBB,1例暴发性心肌炎仍为LBBB并伴心脏增大及心功能减低;1例2月龄扩张型心肌病合并LBBB因心力衰竭加重而死亡,余儿童无不适,心电图无变化,心功能、左室射血分数均无显著变化。结论儿童LBBB最常见的病因为先天性心脏病外科手术及室间隔缺损封堵术后等,临床上应尽早诊断及处理,并且密切随访。

Objective To investigate the etiology,clinical features and prognosis of left bundle branch block(LBBB)in children.Method The clinical data of children diagnosed with LBBB from January 2013 to December 2018 were retrospectively analyzed.Results There were 43 patients with LBBB(35 boys and 8 girls),and the median age was 36 months(9-72 months).There were 36 cases of complete LBBB and 7 cases of left anterior branch block.Cardiac enlargement occurred in 36 cases and cardiac function decreased in 16 cases.Twelve patients had a history of surgery for congenital heart disease(CHD),including ventricular septal defect(VSD)repair in 7 cases and complicated CHD in 5 cases.Closure of VSD was performed in 12 cases.There were 6 cases of cardiomyopathy,4 cases of myocarditis,4 cases of CHD before operation,and 3 normal children.There were 1 cases of craniocerebral trauma and 1 cases of drowning.LBBB occurred in 12 cases 1-7 days after the closure of VSD.After treatment with methylprednisolone and myocardial nutrition,8 cases recovered immediately;4 cases were not recovered after treatment,and sinus rhythm was restored after surgical removal of occluder and repair of VSD from 3 to 8 days after interventional occlusion.LBBB was found in 12 cases of CHD after surgery.After treatment with hormones,nourishing myocardium and other drugs,all 8 cases returned to sinus rhythm,1 case still had LBBB;3 cases developed LBBB after repair of VSD,which gradually progressed to degree III atrioventricular block,and permanent cardiac pacemakers were implanted.The median follow-up time was 24 months(12-49 months).One patient returned to normal early after VSD occlusion,but delayed LBBB appeared at 7 months follow-up.At the end of the follow-up,one patient still had LBBB after surgery for complicated CHD and one patient with fulminant myocarditis still had LBBB accompanied by cardiac enlargement and cardiac dysfunction.One case of dilated cardiomyopathy complicated with LBBB died due to aggravation of heart failure at the age of 2 months.The remaining children had no discomfort,no changes in electrocardiogram,no abnormalities in cardiac function and left ventricular ejection fraction.Conclusions The most common causes of LBBB in children are surgery for CHD and closure of VSD.Clinical diagnosis and treatment should be made as soon as possible,and close follow-up should be conducted.