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目的心脏再同步治疗(cardiacresynchronizationtherapy,CRT)已被证实是治疗药物治疗无效的难治性充血性心力衰竭患者的一种有效方法。但是虽然植入技术在不断进展,仍然有许多问题尚未解决。本文介绍本组病例在术中出现的一些特殊情况的相应处理方法。方法从1999年2月至今50余例患者均成功完成CRT植入治疗。在3例患者中留置了经皮腔内冠状动脉成形术(PT-CA)导丝稳定导线。5例患者发生冠状静脉损伤,但仍顺利完成了植入手术。2例早期行CRT治疗的患者在起搏器更换时发现起搏阈值过高。结果留置PTCA导丝的3例患者术中测试起搏阈值满意,未出现任何并发症。5例发生冠状静脉损伤的患者也同样顺利完成冠状静脉导线的植入。2例患者在更换起搏器时成功拔除了2188导线。结论冠状静脉导线的植入是CRT治疗术中的关键步骤,及时发现和处理一些特殊的情况能提高手术的成功率。
Cardiac resynchronization therapy (CRT) has been shown to be an effective method for the treatment of refractory congestive heart failure patients who are refractory to medical therapy. However, while implant technology is evolving, many problems remain unresolved. This article describes the group of patients in the operation of some special cases of the corresponding treatment. Methods From February 1999 to the present more than 50 patients were successfully completed CRT implantation. Percutaneous transluminal coronary angioplasty (PT-CA) guidewire stabilization wire was placed in 3 patients. Five patients developed coronary vein injury but successfully completed the implantation procedure. In 2 patients who underwent early CRT therapy, they found that the pacing threshold was too high during pacemaker replacement. Results The three patients with PTCA guidewire had satisfactory intraoperative thoracic pacing threshold without any complications. Five patients with coronary vein lesions also successfully completed the implantation of coronary vein catheters. Two patients successfully removed the 2188 lead when changing pacemakers. Conclusion The implantation of coronary venous lead is a key step in the treatment of CRT. The timely detection and treatment of some special cases can improve the success rate of surgery.