Electrophysiologic consequences of the Mustard repair of d-transposition of the great arteries.
Electrophysiologic consequences of the Mustard repair of d-transposition of the great arteries.
复制标题
大动脉 d 转位芥末修复的电生理后果。
DOI：
10.1016/s0735-1097(87)80129-8
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发表时间：
1987
影响因子：
24
通讯作者：
Horowitz,LN
中科院分区：
文献类型：
--
作者：
Vetter,VL;Tanner,CS;Horowitz,LN
本研究描述了Mustard修复大动脉d型转位对窦房结以及对心房、房室结和心室传导和不应性的电生理影响。对64例Mustard手术后患者进行了72项电生理检查。评价标准静息和24小时动态心电图。在72项研究中，67项研究中的导管心房内标测显示，33例患者的心房内存在窦性心律，26例患者存在异位房性心律，8例患者存在交界性心律。在59例房性或窦性心律患者中，53例存在心房内传导延迟，房室交界处的低位内侧、低位外侧或低位右心房激动非常晚。仅9例患者的窦房结功能正常，与新右心房的左心房部分相比，新右心房的右心房部分的不应期延长。41%的患者心房不应期延长，起搏周期缩短。51%的患者在程控心房刺激下出现持续性心房内折返。这些可诱导房性心动过速的患者中有48%发生了心房扑动的临床发作，总之，电生理研究显示窦房结功能和心房传导明显异常，且不应期。这些异常单独或联合使用，可导致严重心动过缓或快速房性心律失常，可能导致猝死。Jatene或动脉转换术可为这组患者提供适当的替代手术。
This study describes the electrophysiologic effects of the Mustard repair of d-transposition of the great arteries on the sinus node and on conduction and refractoriness in the atrium, atrioventricular (AV) node and ventricle. Seventy-two electrophysiologic studies were performed on 64 patients after the Mustard operation. Standard rest and 24 hour ambulatory electrocardiograms were evaluated. Catheter endocardial atrial mapping, available in 67 of the 72 studies, revealed that sinus rhythm was present in the atria in 33 patients, ectopic atrial rhythm in 26 and junctional rhythm in 8. Intraatrial conduction delays with very late activation of the low medial, low lateral or low right atrium at the AV junction were present in 53 of 59 patients with atrial or sinus rhythm. Sinus node function was normal in only nine patients.Prolonged refractory periods were found in the right atrial portion of the new right atrium when compared with the left atrial portion of the new right atrium. Fortyone percent of the patients had prolongation of atrial refractoriness with shortening of the paced cycle lengths. Fifty-one percent developed sustained intraatrial reentry with programmed atrial stimulation. Forty-eight percent of these patients with inducible atrial tachycardia have since developed clinical episodes of atrial flutter.In summary, electrophysiologic studies revealed significant abnormalities of sinus node function and atrial conduction and refractoriness. Alone or in combination, these abnormalities, which result in severe bradycardia or rapid atrial arrhythmias, may lead to sudden death. The Jatene or arterial switch procedure may provide an appropriate alternative operation in this group of patients.