心脏介入性治疗中合并即刻与迟发心脏压塞

Cardiac tamponade occurred during and late after cardiac interventional therapy

目的 总结心脏介入性治疗术中发生的心脏压塞的临床特点和诊治经验。方法 回顾分析心脏起搏器植入术、快速心律失常射频导管消融术和冠心病介入性治疗中心脏压塞的临床特点和处理的方式及结果。结果 8例患者发生心脏压塞 ,其中男性 5例 ,女性 3例 ,年龄 4 8～ 73岁。介入性治疗术中即刻出现填塞症状 5例 ,迟发症状 3例 ;救治成功 7例 ,死亡 1例。其中起搏器植入术 2例 ,射频导管消融术 3例 ,并发于冠心病介入性治疗术 3例。结论 心脏介入性治疗合并即刻和迟发两类心脏压塞 ,多与操作不当有关。应提高认识 ,加强防范意识 ,改进操作技巧。

Objective To report the cardiac tamponade complicating various cardiac interventional therapies in our department during last ten years.Methods The clinical characteristics of the cardiac tamponade were analyzed in patients undertaking cardiac pacemaker implantation,radiofrequency catheter ablation and various interventional therapies for coronary artery diseases.Results A total of 8 patients experienced cardiac tamponade during last ten years.There were 5 men and 3 women with the age ranging from 48 to 73 years old.Cardiac tamponade occurred instantly during the procedure in 5 patients and 2 to 5 days after the procedure in 3 patients.Seven patients were properly recognized and successfully treated and another patient with delayed cardiac tamponade died without correct diagnosis.In one patient,cardiac tamponde was caused by perforation of right ventricular apex with pacemaker lead.In one patient,it was caused by leaking of blood at the site of skew-in pacemaker lead partly due to antithrombotic therapy.In three patients undergoing radiofrequecy catheter ablation,perforation of right atrium,right ventricular outflow tract free wall and aortic root was found respectively.Cardiac tamponade was caused by perforation of the left descending coronary artery in remaining 3 patients.Conclusion Cardiac tamponade occurs instantly during and late after the interventional procedures for heart diseases.It associated with difficulties in manipulating the catheter or guide-wire in the majority of cases.To reduce the complication incidence,caution must be taken in manipulating catheter or guide-wire while performing cardiac interventional procedures.