儿童和青少年经皮膜周室间隔缺损闭合后传导障碍的发生率、危险因素和结局:一项中期随访

IF 0.4 4区医学 Q4 PEDIATRICS

Iranian Journal of Pediatrics Pub Date : 2023-09-15 DOI:10.5812/ijp-135528

Mohammadreza Edraki, Majid Farrokifar, Hamid Amoozgar, Nima Mehdizadegan, Hamid Mohammadi, Amir Naghshzan, Elahe Nirooie

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引用次数: 0

摘要

背景:传导障碍(CD)是经皮膜周室间隔缺损(pmVSD)闭合术的主要并发症。目的:本研究旨在调查经皮缝合这些缺损后持续CD的发生率、易感因素和结果。方法:2016年4月至2021年4月期间，所有经皮方法成功闭合pmVSD的患者入组该队列研究。通过经胸超声心动图和导管插管确定缺损的大小、间隔动脉瘤和到主动脉瓣环的距离。术中及术后1小时进行持续心脏监测，定期获取标准12导联心电图，以确定是否有CD和心律失常。结果:共有260例成功关闭pmVSD的患者入组研究。本研究中，男性135例(52%)，女性125例(48%)。患者平均年龄为75.66±68.89个月。患者的中位随访时间为36个月(范围:9-210个月)。31例(11.9%)出现持续性CD, 25例恢复正常传导。此外，7例(2.7%)患者有几种永久性传导异常，包括4例右束支传导阻滞，2例左束支传导阻滞，1例双束传导阻滞。没有人有永久性房室传导阻滞。非动脉瘤性缺陷的闭合和更长的手术时间是CD的独立危险因素。使用Amplatzer II型导管闭塞器与传导异常的发生率较低相关。结论:经导管关闭后持续性CD的发生率较高;然而，大多数病例恢复到正常的传导。使用较软的装置和将装置置入间隔动脉瘤可能会降低CD的风险。

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Incidence, Risk Factors, and Outcomes of Conduction Disturbances After Percutaneous Closure of Perimembranous Ventricular Septal Defects in Children and Adolescents: A Mid-Term Follow-up

Background: Conduction disturbance (CD) is a major complication of percutaneous closure of the perimembranous ventricular septal defect (pmVSD). Objectives: This study aimed to investigate the incidence, predisposing factors, and outcomes of sustained CD following percutaneous closure of these defects. Methods: All patients whose pmVSD was closed successfully with percutaneous methods within April 2016 to April 2021 were enrolled in this cohort study. The defects’ size, septal aneurysms, and distance to the aortic valve annulus were determined with transthoracic echocardiography and catheterization. Continuous heart monitoring was performed during the procedures and one hour after, and standard 12-lead electrocardiograms were obtained regularly to determine any CD and arrhythmias. Results: A total of 260 patients who had successful pmVSD closure were enrolled in the study. In this study, 135 (52%) and 125 (48%) patients were male and female, respectively. The mean age of the patients was 75.66 ± 68.89 months. The patients’ median follow-up was 36 months (range: 9-210 months). Thirty-one patients (11.9%) developed sustained CD, and 25 cases recovered to normal conduction. Additionally, 7 patients (2.7%) had several permanent conduction abnormalities, including four right bundle branch blocks, two left bundle branch blocks, and one bi-fascicular block. No one had a permanent atrioventricular block. Closure of non-aneurysmal defects and more prolonged procedures were independent risk factors of CD. Using Amplatzer duct occluder type II was associated with less incidence of conduction abnormalities. Conclusions: The incidence of sustained CD after transcatheter closure was relatively high; however, most cases recovered to normal conduction. The use of softer devices and the placement of devices into the septal aneurysms might lower the risk of CD.

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来源期刊

Iranian Journal of Pediatrics 医学-小儿科

CiteScore

0.90

自引率

20.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Iranian Journal of Pediatrics (Iran J Pediatr) is a peer-reviewed medical publication. The purpose of Iran J Pediatr is to increase knowledge, stimulate research in all fields of Pediatrics, and promote better management of pediatric patients. To achieve the goals, the journal publishes basic, biomedical, and clinical investigations on prevalent diseases relevant to pediatrics. The acceptance criteria for all papers are the quality and originality of the research and their significance to our readership. Except where otherwise stated, manuscripts are peer-reviewed by minimum three anonymous reviewers. The Editorial Board reserves the right to refuse any material for publication and advises that authors should retain copies of submitted manuscripts and correspondence as the material cannot be returned. Final acceptance or rejection rests with the Editors.