靠右心室起搏的婴儿产生了双心室起搏，由此导致了心力衰竭-病例（英文）PPT.ppt

TC Yung Paediatric Cardiology Unit Grantham Hospital Hong Kong;Male baby Antenatal at 21 week of gestation noted have bradycardia and AV block mother anti Ro, RF + ve LSCS at 35 weeks for progressive fetal heart failure, birth weight 2.36 kg Post-natal Respiratory distress CXR : cardiomegaly, CT ratio 67% Put on nasal CPAP + Isoprenaline infusion;;CT ratio 67%;Transfer to TGH on the day of birth Echo showed normal heart structure, LVSF 38.9%, LVEDD 2.78cm LVEF 77.2% HR ~ 50-60/min, systolic BP 55mmHg while on isoprenaline infusion ;Paradoxical septal motion, LVEDD 2.1cm, FS 25.3% , LVEF 58%;ECHO post DDD pacing:;;Pericardial effusion ; LVEDD 2.76cm, FS 14.6%, EF 37.8% Dilated LV cavity;3.5 months post RV pacing Significant heart failure symptom: tachypnea and fluid retention Echo - dilated LV, LVEDD 3.3 cm - Moderate tricuspid and mitral incompetence Poor LV contraction , LVFS 5% LVEF 14.3% ECG showed irregular rhythm, Wenckebach phenomenon due to rapid atrial rate while on DDD pacing Pace mode changed to VVI 130/min Hospitalized for dobutamine infusion ;ECHO progressive LV dilatation; Severe LV dysynchrony, LVPW – Septal delay 255ms;3 days after admission When VVI turned off ? intrinsic escape rhythm, synchronized LV contraction ? pacing rate to 55/min and started isoprenaline to promote synchronized contraction, But heart failure continued to deteriorate The baby was intubated for 5 days RV pacing rate was increased to 120/min Plan ? Biventricular epicardial pacing ; LV epicardial pacing LV lead threshold = 1.0 v , 0.4ms RV/LV delay = 4ms (LV first) ;1 day after biventricular pacing;Post bivent pacing LVPW – Septal delay 65ms; Second day post biventricular pacing Sense AV intervals VTI of LVOT 50ms 8.3 80ms 9.1 100ms 9.1 120ms 8.5 140ms 5.8 V-V delay LV first VTI of LVOT (sense AV 100ms) 4 ms 7.8