Delayed heart block after temporary balloon occlusion of a secundum atrial septal defect.
Delayed heart block after temporary balloon occlusion of a secundum atrial septal defect.
复制标题
继发孔房间隔缺损临时球囊闭塞后延迟性心脏传导阻滞。
DOI：
10.1161/circep.108.818450
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Das,Saumya
中科院分区：
文献类型：
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作者：
Singh,SheldonM;Das,Saumya
虽然房性心律失常与房间隔缺损（ASD）之间的相关性已得到充分描述，但房室结传导异常（通常在ASD器械闭合的情况下）的报告很少。1-4我们报告一例暂时性球囊闭塞继发性房间隔缺损后数小时出现短暂性完全性心脏传导阻滞。据我们所知，这是第一个报告，描述延迟完全性心脏传导阻滞与暂时性球囊闭塞的ASD。一个35岁的女性艾森曼格综合征继发于继发性ASD和异常肺静脉引流住院希克曼线感染。考虑到存在赘生物和脓毒性肺栓塞，决定取出管路。为避免全身性赘生物栓塞，计划在取出管路时暂时封堵ASD。患者既往无心脏传导阻滞病史，基线ECG显示PR间期正常（图，图A）。将34 mm Amplatzer球囊放置在ASD上并充盈（腰部直径16 mm），以闭塞右心房和左心房之间的血流（图B）。在操纵和移除Hickman线的过程中，球囊保持充盈25分钟。未观察到术中血流动力学或传导异常。术后18小时，患者发生晕厥，记录为高度房室传导阻滞（C图）。发作持续3分钟，并自发恢复正常AV传导。她接受了额外7天的院内遥测监测，并接受了21天的门诊事件监测。未再发生房室传导阻滞。暂时性房室传导阻滞被描述为ASD器械闭合的并发症。1，2在迄今为止最大的系列中，3.1%和0.6%的患者发生了短暂的第二和第三次
Although the association between atrial arrhythmias and atrial septal defects (ASD) has been well described, abnormalities of AV nodal conduction, typically in the setting of ASD device closure, have been infrequently reported. 1–4 We report a case of transient complete heart block several hours after temporary balloon occlusion of a secundum ASD. To our knowledge, this is the first report describing delayed complete heart block with temporary balloon occlusion of an ASD.A 35-year-old woman with Eisenmenger’s syndrome secondary to a secundum ASD and anomalous pulmonary venous drainage was hospitalized with a Hickman line infection. The decision was made to remove the line, given the presence of vegetations and septic pulmonary emboli. To avoid systemic vegetation embolization, temporary occlusion of the ASD at the time of the line removal was planned. The patient had no prior history of heart block and a normal PR interval on a baseline ECG (Figure, panel A). A 34-mm Amplatzer balloon was placed across the ASD and inflated (waist diameter 16 mm) to occlude flow between the right and left atria (panel B). The balloon remained inflated for 25 minutes during manipulation and removal of the Hickman line. No intraprocedural hemodynamic or conduction abnormalities were noted. Eighteen hours after the procedure the patient experienced syncope with documented high-grade AV block (panel C). The episode persisted for 3 minutes with spontaneous resumption of normal AV conduction. She was monitored with in-hospital telemetry for an additional 7 days and with an outpatient event monitor for 21 days. There were no further episodes of AV block. Transient AV block has been described as a complication of ASD device closure. 1, 2 In the largest series to date, 3.1% and 0.6% of patients developed transient second and third