心耳切除术治疗儿童心耳起源房性心动过速的疗效探讨

Therapeutic efficacy of auricular appendectomy for atrial tachycardia derived from atrial appendage in children

目的分析心导管射频消融术结合心耳切除术治疗心耳起源房性心动过速的临床经验及治疗效果。方法回顾2016年9月至2021年9月上海交通大学医学院附属上海儿童医学中心收治的6例心耳起源房性心动过速实施心耳切除术的患儿资料。所有病例均为射频消融治疗后复发,其中男3例,女3例,年龄4~12岁,体质量17~46 kg。4例起源于左心耳,2例起源于右心耳。患儿行心导管射频消融术及心耳切除术治疗,术前完善心电图、胸部平片等检查。结果6例患儿术前超声心动图测得左心射血分数(50±12)%,左心房内径(2.68±0.69)cm,左心室舒张末期内径(4.52±0.54)cm。胸部X线正位片测心胸比为(0.59±0.06)。5例行经胸心耳切除术,1例行电视胸腔镜左心耳切除术,所有患儿术后即刻转为窦性心律。2例右心耳切除术患儿分别于术后2 d及2个月出现复发,再次射频消融后无复发。术后超声心动图测得左心射血分数(63.5±5.7)%,左心房内径(2.36±0.36)cm,左心室舒张末期内径(4.27±0.57)cm。胸部X线正位片测心胸比(0.48±0.02)。随访3个月至5年,无一例死亡,未发现严重并发症。结论对于射频消融术后出现复发的心耳起源的房性心动过速患儿,心耳切除术是一种有效的治疗手段,左心耳切除术效果优于右心耳切除术。

Objective To explore the clinical experience and therapeutic efficacy of radiofrequency catheter ablation plus atrial appendectomy for atrial tachycardia of atrial appendage origin.Methods From September 2016 to September 2021,retrospective analysis was performed for 6 children with atrial tachycardia derived from atrial appendage undergoing atrial appendage resection.There were 3 boys and 3 girls with an age range of(4-12)years.The originating atrial appendage was left(n=4)and right(n=2).All cases recurred after radiofrequency ablation,atrial appendectomy for atrial tachycardia of atrial appendage origin was performed.Electrocardiogram and chest X-ray were performed preoperativly.Results Preoperative ultrasonic values were left ventricular ejection fraction(LVEF)(50±12%),left atrium(LA)(2.68±0.69)cm,left ventricular end-diastolic dimension(LVDD)(4.52±0.54)cm and cardiothoracic ratio(0.59±0.06).Transthoracic atrial appendage resection(n=5)and video-assisted thoracoscopic left atrial appendage resection(n=1)were performed.All of them regained sinus rhythm immediately postoperatively.However,two cases of right atrial appendage resection recurred at Day 2 and Month 2 postoperatively.No recurrence was noted after radiofrequency ablation.Postoperative ultrasonic values were LVEF(63.5±5.7)%,LA(2.36±0.36)cm,LVDD(4.27±0.57)cm and cardiothoracic ratio(0.48±0.02).There was no mortality or serious complications during a follow-up period of 3 months to 5 years.Conclusions Atrial resection is an effective treatment for recurrent atrial tachycardia originating from atrial appendage after radiofrequency ablation.Left atrial appendage resection fares better than right atrial appendage resection.Video-assisted thoracoscopic resection of left atrial appendage is mini-invasive,safe and effective.