Thrombosis in the proximal pulmonary artery stump in a Fontan patient
Thrombosis in the proximal pulmonary artery stump in a Fontan patient
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Fontan 患者近端肺动脉残端血栓形成
作者：
F. U. T. Cate;J. M. Breur;N. Boramanand;J. Crosson;Allan H. Friedman;Joel I. Brenner;E. Meijboom;N. Sreeram
目的：比较类固醇洗脱心外膜和心内膜电极导线在需要永久起搏的婴儿和儿童中的性能。方法：评价植入95名儿童的159根类固醇洗脱电极导线的起搏和感知特性、阻抗和寿命。A组包括24名体重小于15 kg的儿童，植入15根心内膜电极导线（5根心房电极导线，10根心室电极导线）和19根心外膜电极导线（5根心房电极导线，14根心室电极导线）。B组为71例体重大于15 kg的儿童，植入106根心内膜电极导线（心房56根，心室58根）和19根心外膜电极导线（心房9根，心室10根）。结果如下：A组：植入时（平均值（SD）0.84（0.54）v 1.59（0.64）V，p < 0.014）和2年随访时（心室0.64（0.24）v 1.65（0.69）V，p < 0.003），心室内膜电极导线的刺激阈值较低。在植入和随访时，阻抗和感知阈值没有显著差异。B组：植入时（0.72（0.48）v 1.48（0.58）V，p < 0.001）和随访时（0.88（0.46）v 1.55（0.96）V，p < 0.009），心室内膜电极导线的刺激阈值较低。阻抗没有差异。随访时心室内膜电极导线的感知阈值也更好（9.1（5.2）v14.2（6.4）mV，p < 0.02）。两组均发生了需要干预的并发症（心内膜电极导线n = 7，心外膜电极导线n = 18）。结论：在儿科人群中，心内膜和心外膜类固醇洗脱电极导线的性能相当。
Aim: To compare the performance of steroid eluting epicardial and endocardial leads in infants and children requiring permanent pacing. Methods: Evaluation of pacing and sensing characteristics, impedances, and longevity of 159 steroid eluting leads implanted in 95 children. Group A consisted of 24 children weighing less than 15 kg with 15 endocardial leads (five atrial, 10 ventricular) and 19 epicardial leads (five atrial, 14 ventricular). Group B consisted of 71 children weighing more than 15 kg with 106 endocardial leads (56 atrial, 58 ventricular) and 19 epicardial leads (nine atrial, 10 ventricular). Results: Group A: Stimulation thresholds were lower for ventricular endocardial leads at implant (mean (SD) 0.84 (0.54) v 1.59 (0.64) V, p < 0.014) and at two year follow up (ventricular 0.64 (0.24) v 1.65 (0.69) V, p < 0.003). Impedance and sensing thresholds did not differ significantly at implant and follow up. Group B: Stimulation thresholds were lower for ventricular endocardial leads at implant (0.72 (0.48) v 1.48 (0.58) V, p < 0.001) and at follow up (0.88 (0.46) v 1.55 (0.96) V, p < 0.009). Impedance did not differ. Sensing thresholds were also better for ventricular endocardial leads at follow up (9.1 (5.2) v 14.2 (6.4) mV, p < 0.02). Complications requiring intervention occurred in both groups (n = 7 for endocardial v n = 18 for epicardial leads). Conclusions: Endocardial and epicardial steroid eluting leads have comparable performance in the paediatric population.