儿童经皮室间隔缺损封堵术后完全性左束支传导阻滞25例临床分析

Clinical analysis of complete left bundle branch block after transcatheter closure of ventricular septal defect in 25 children

目的:总结经皮室间隔缺损(VSD)封堵术后完全性左束支传导阻滞(CLBBB)患儿的治疗经验。方法:病例系列研究。收集2010年1月至2023年12月在广东省人民医院行VSD封堵术,术后发生CLBBB的25例患儿的治疗经过及随访结局。采用配对样本t检验评估治疗效果。结果:本研究25例患儿中,男12例(48%),女13例(52%),手术年龄为3.18(2.51~3.86)岁,术前身高为95.0(90.0~97.5)cm,术前体重为13(12~15)kg。14例为早发型(≤1个月发现),11例为迟发型(>1个月发现),随访时间为(6.63±3.93)年。14例早发型患儿中,6例于1个月内行封堵器取出术,术后恢复正常心律或不完全性右束支传导阻滞;4例于术后1个月取封堵器,2例恢复正常,1例仍为CLBBB,1例出现完全性房室传导阻滞(CAVB);4例经内科药物治疗后,2例恢复正常心律,1例为左前分支传导阻滞,1例因心源性休克、心力衰竭死亡。11例迟发型患儿经内科治疗后,3例恢复正常心律,8例为持续CLBBB(1例术后8个月行封堵器取出后恢复正常心律,1例出现CAVB,6例仍为CLBBB)。结论:VSD封堵术后CLBBB内科治疗效果欠佳,且易复发,建议发现CLBBB后立即行封堵器取出术;持续性CLBBB建议密切随访,必要时行起搏器植入术。

ObjectiveTo summarize the clinical treatment of complete left bundle branch block(CLBBB)after the transcatheter closure of ventricular septal defect(VSD).MethodsA case series study was conducted on the treatments and outcomes of 25 children with CLBBB after transcatheter VSD closure in Guangdong Provincial People′s Hospital from January 2010 to December 2023.Paired sample t test was used to evaluate the effect of occlude removal.ResultsAmong the 25 patients,12 were males(48%),and 13 were females(52%).The age at surgery was 3.18(2.51-3.86)years,the height before surgery was 95.0(90.0-97.5)cm,and the weight before surgery was 13(12-15)kg.Fourteen children were early-onset cases(≤1 month),while the other 11 were late-onset cases(>1 month).The mean follow-up time was(6.63±3.93)years.Of the 14 early-onset cases,6 children underwent occluder removal within 1 month and restored normal heart rhythm or incomplete right bundle branch block;4 children underwent occluder removal after 1 month,of whom 2 recovered,1 remained CLBBB,and 1 had complete atrioventricular block(CAVB);the other 4 children received drug treatment,of whom 2 had normal heart rhythm,1 had left anterior fascicular block,and 1 died of cardiac shock and heart failure.All the 11 late-onset cases were first treated by drugs,of whom 3 recovered,and the other 8 remained CLBBB.One of the 8 cases received occluder removal at 8 months after surgery and recovered,1 had CAVB,and the other 6 remained CLBBB.ConclusionsFor patients with CLBBB after transcatheter closure of VSD,drug therapy is not always effective,and CLBBB is easy to recur.Therefore,occluder removal is recommended to be done immediately after CLBBB is discovered.Patients with persistent CLBBB should be followed up regularly,and pacemaker implantation may be performed if necessary.