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目的探讨室间隔缺损(VSD)介入术后并发完全性左束支传导阻滞(CLBBB)的高危因素及预后。方法回顾2010年4月至2015年12月南京医科大学附属儿童医院心脏中心VSD介入术后并发CLBBB 9例患儿的一般资料及随访结果,分析9例患儿年龄、VSD及封堵器类型、术后CLBBB出现时间及转归、左心室舒张末期内径(LVEDD)及左心室射血分数(LVEF)变化情况。结果年龄:除1例年龄偏大外,其余8例均在5岁以内。VSD及封堵器类型:膜周型VSD伴假性膨出瘤3例,嵴内型VSD 6例;1例选择对称型封堵器,2例选择小腰大边型封堵器,6例选择偏心型封堵器。术后CLBBB出现时间及转归:术后3 d内8例、术后1个月1例;8例术后早期并发CLBBB患儿在住院期间经药物治疗后有4例恢复正常,其中2例术后1个月复查,再次出现CLBBB;1例术后1个月开始出现CLBBB的患儿接受外科手术后,次日CLBBB恢复正常。LVEDD及LVEF变化:2例分别于术后6、12个月出现不同程度LVEDD增大,其余7例未出现明显LVEDD增大,9例均未出现LVEF下降。结论VSD介入治疗应严格遵循专家共识、规范化操作;对低龄VSD患儿介入封堵治疗应谨慎;在保证封堵治疗效果的前提下,尽量选择对称型封堵器。VSD介入术后并发CLBBB近期预后良好,但部分病例远期出现LVEDD增大,对于术后出现CLBBB病例,应严格长期随访。
Objective To investigate the risk factors and prognosis of patients with complete left bundle branch block (CLBBB) after ventricular septal defect (VSD) intervention. Methods From April 2010 to December 2015, the general data and follow-up results of 9 children with CLBBB after the interventional treatment of VSD in Children’s Hospital of Nanjing Medical University from April 2010 to December 2015 were analyzed. The age, VSD, type of occluder, Postoperative CLBBB appearance and outcome, left ventricular end diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) changes. Results Age: Except for 1 case of older age, the remaining 8 cases were within 5 years old. VSD and occluder type: 3 cases of peritubular VSD with pseudo-bulging tumor, 6 cases of intracristal VSD, 1 case of selective occluder, 2 cases of small occluder and 6 cases of occluder Choose eccentric occluder. The time and outcome of postoperative CLBBB: 8 cases within 3 days after operation and 1 case after 1 month; 8 cases with CLBBB in early postoperative period were recovered to normal after inpatient treatment, of which 2 cases One month after the operation, CLBBB again appeared; one case of CLBBB who started to have CLBBB one month after surgery underwent surgery and the next day CLBBB returned to normal. LVEDD and LVEF changes: LVEDD increased in 2 cases at 6 and 12 months postoperatively, and no significant LVEDD increased in the remaining 7 cases, and no decrease of LVEF occurred in 9 cases. Conclusion Interventional treatment of VSD should strictly abide by the consensus of experts and standardization operation. It should be cautious in interventional occlusion treatment of children with younger VSD. Symmetric occluder should be chosen as far as possible to ensure the efficacy of closure therapy. The recent prognosis of CLBBB after VSD intervention is good, but in some cases LVEDD increases in the long term. CLBBB cases should be followed up strictly for a long time.