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目的探讨经导管介入治疗小儿膜周部室间隔缺损(VSD)发生高度房室传导阻滞(AVB)的特点及其处理。方法选择我科年龄小于12岁VSD患者,经导管介入治疗发生高度AVB的患儿,共计9(男4,女5)例,连续观察所有患儿封堵术前以及发生高度AVB后ECG的变化及其处理。结果①术中发生高度AVB5例,分别在AVB后10min～46h恢复正常窦性心律。其中3例为持续Ⅲ度AVB,经处理后2例转为持续Ⅱ度Ⅱ型,1例仍为持续Ⅲ度AVB;间歇性Ⅱ度Ⅱ型和Ⅲ度AVB各1例。②4例在术后12h～10d出现AVB,3例在AVB后1～12d恢复;1例未恢复,给予永久起搏器治疗。其中3例为间歇性高度或Ⅲ度AVB,1例为持续性Ⅲ度AVB。③术后AVB恢复的3例,在高度AVB时,ECG均表现为完全性右束支传导阻滞+左前分支传导阻滞。AVB后3～5d,ECG电轴左偏进一步加重,以后电轴左偏逐渐减轻,左前分支阻滞逐渐消失,至恢复时ECG仅遗留右束支传导阻滞。结论小儿膜周部VSD介入治疗有发生高度AVB的危险。对于高危患者,应尽早治疗。
Objective To investigate the characteristics and treatment of high degree atrioventricular block (AVB) in children with perimembranous ventricular septal defect (VSD) after catheterization. Methods A total of 9 (4 males and 5 females) children with VSD undergoing transcatheter catheterization were enrolled in this study. ECG changes of all children before and after the closure of AVB were observed continuously And its treatment. Results ① The intraoperative high AVB 5 cases, respectively, after AVB 10min ~ 46h to restore normal sinus rhythm. Three of them were sustained AVB Ⅲ, two of them were converted to persistent Ⅱ degree Ⅱ type after treatment, and 1 case remained AVB Ⅲ. Intermittent type Ⅱ and Ⅲ AVB were found in 1 case. ② In 4 cases, AVB occurred at 12h ~ 10d after operation and in 1 ~ 12d after AVB. One patient did not recover and was given permanent pacemaker treatment. Three of them were intermittent or third degree AVB, and one was persistent third degree AVB. ③ Postoperative AVB recovery in 3 cases, at a high AVB, ECG showed complete right bundle branch block + left anterior branch block. After 3 to 5 days after AVB, the left ECG axis was further aggravated. After that, the left axial deviation was gradually reduced and the left anterior branch block gradually disappeared. Only the right bundle branch block remained during the ECG recovery. Conclusion Peripheral VSD in pediatric patients is at high risk for AVB. For high-risk patients, treatment should be as soon as possible.