Successful cardiac resynchronization therapy in a 3-year-old girl with isolated left ventricular non-compaction and narrow QRS complex: a case report.
Successful cardiac resynchronization therapy in a 3-year-old girl with isolated left ventricular non-compaction and narrow QRS complex: a case report.
复制标题
一名患有孤立性左心室致密化不全和狭窄 QRS 波群的 3 岁女孩成功进行心脏再同步治疗：病例报告。
DOI：
10.1253/circj.cj-08-0806
复制
发表时间：
2009
期刊：
影响因子：
--
通讯作者：
T. Miyawaki
中科院分区：
文献类型：
--
作者：
K. Saito;K. Ibuki;Naoki Yoshimura;K. Hirono;Sayaka Watanabe;Kazuhiro Watanabe;K. Uese;S. Yasukouchi;F. Ichida;T. Miyawaki
心脏复律治疗（CRT）是治疗难治性心力衰竭的一种新方法。然而，对于儿童，其适应症，疗效和长期预后仍不清楚。本研究描述了一名3岁女孩，因孤立性左室致密化不全（LVNC）伴窄QRS波群而导致顽固性心力衰竭，并使用CRT治疗。超声心动图显示左心室（LV）壁运动弥漫性减退（射血分数=29.3%），心尖、后壁和侧壁之间不同步，存在大量突出的小梁，以及重度二尖瓣返流。在全身麻醉下使用心外膜起搏电极导线进行双心室起搏。使用组织多普勒成像选择心室壁中最佳同步的起搏部位，并调整AV延迟以实现最大收缩压和最大心输出量。在2年的随访期内，她表现出左心室功能和临床症状的显著和持续改善。BNP水平从1，960降至82 pg/ml。CRT后ECG上的QRS时限（103 ms）无变化。我们的结论是，儿童CRT提供了一个非常有用的辅助治疗心力衰竭，即使在患者的QRS时限窄，并可能改善患者的预后与LVNC。
Cardiac resynchronization therapy (CRT) is a new method of treatment for refractory heart failure. However, for children, its indication, efficacy, and long-term prognosis remain unclear. This study describes the use of CRT for a 3-year-old girl with intractable heart failure caused by isolated left ventricular non-compaction (LVNC) with narrow QRS complex. Echocardiography showed diffuse hypokinetic left ventricular (LV) wall motion (ejection fraction =29.3%) with dyssynchrony between the apex, posterior and lateral walls, where numerous prominent trabeculations existed, and severe mitral regurgitation. Biventricular resynchronization using epicardial pacing leads was performed under general anesthesia. Pacing sites for optimal synchronization in the ventricular walls where chosen using tissue Doppler imaging, and AV delay was adjusted to achieve maximal systolic blood pressure and maximal cardiac output. Over a follow-up period of 2 years, she exhibited significant and sustained improvement in LV function and clinical symptoms. BNP levels decreased from 1,960 to 82 pg/ml. QRS duration (103 ms) on ECG did not change after CRT. We conclude that pediatric CRT provides a highly useful adjunct for the treatment of heart failure, even in patients with a narrow QRS duration, and might improve the prognosis of patients with LVNC.