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目的分析对称型和不对称型封堵器介入治疗膜周部室间隔缺损(PMVSD)术后传导阻滞的发生率及其影响因素。方法成功植入106例偏心型室间隔缺损封堵器(AVSDO)和122例对称型室间隔缺损封堵器(SVSDO)的PMVSD患者,于术前、术后1周、1、3、6个月及每年分别行常规ECG和Holter检查。结果术后新发生传导阻滞33例,AVSDO组与SVSDO组发生率无统计学差异(14.2%vs.14.8%)(P>0.05)。33例中以右束支传导阻滞(RBBB)最常见(19例),其次为左束支传导阻滞(LBBB)(8例)和房室传导阻滞(AVB)(6例);1例Ⅱ度Ⅱ型AVB和3例Ⅲ度AVB均经临时起搏、激素治疗后恢复为正常窦性心律;出院前21例传导阻滞消失。发生传导阻滞者较未发生者的PMVSD距主动脉瓣距离(DDRAV)长,PMVSD距三尖瓣隔瓣的距离(DDSTV)短,封堵器直径与PMVSD直径的差值(DDOV)大(P<0.05)。新发生传导阻滞出现时间越早越难恢复。结论应用AVSDO和SVSDO介入治疗PMVSD术后传导阻滞发生率相似,且多数能恢复正常。DDSTV、DDRAV和DDOV可作为术后新发传导阻滞较好的预测指标。
Objective To analyze the incidence and influential factors of conduction block after percutaneous transluminal space membrane septal defect (PMVSD) with symmetrical and asymmetric occluders. Methods Sixty-six PMVSD patients with eccentric ventricular septal defect occluder (AVSDO) and 122 patients with symmetric ventricular septal defect occluder (SVSDO) were implanted successfully in preoperative, postoperative 1 week, 1, 3, 6 Month and year, respectively, routine ECG and Holter examination. Results There were 33 new cases of conduction block and no significant difference between AVSDO group and SVSDO group (14.2% vs.14.8%) (P> 0.05). Right bundle branch block (RBBB) was most common in 19 (n = 19), followed by left bundle branch block (n = 8) and atrioventricular block (n = 6) The cases of grade Ⅱ AVB and 3 cases of grade Ⅲ AVB were all treated with temporary pacing and returned to normal sinus rhythm after hormone therapy. The conduction block disappeared in 21 cases before discharge. The PMVSD was longer than the aortic valve distance (DDRAV), the distance from the tricuspid valve (DDSTV) was shorter, and the difference between the diameter of the occluder and the diameter of the PMVSD (DDOV) was larger in those with conduction block than those without P <0.05). The sooner the new block occurs, the harder it will be to recover. Conclusions The incidence of conduction block after AVSDO and SVSDO interventional treatment of PMVSD is similar, and most of them can return to normal. DDSTV, DDRAV and DDOV can be used as good predictors of new postoperative conduction block.