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.ppt

TCYungPaediatricCardiologyUnitGranthamHospitalHongKongBiventricularpacinginababywithRVpacinginducedheartfailureThe10thSouthChinaInternationalCongressofCardiology,Guangzhou,2008

MalebabyAntenatalat21weekofgestationnotedhavebradycardiaandAVblockmotherantiRo,RF+veLSCSat35weeksforprogressivefetalheartfailure,birthweight2.36kgPost-natalRespiratorydistressCXR:cardiomegaly,CTratio67%PutonnasalCPAP+Isoprenalineinfusion

CTratio67%

TransfertoTGHonthedayofbirthEchoshowednormalheartstructure,LVSF38.9%,LVEDD2.78cmLVEF77.2%HR~50-60/min,systolicBP55mmHgwhileonisoprenalineinfusion

EpicardialpacemakerinsertiontheseconddayafteradmissionRARV(inferiorwall)pacingDDD(90-180/min)PostepicardialDDDpacing:CTratio67.9%

MeasurementatOperationLeads4965steroid-elutedleadsforbothRAandRVGenerator-SensiaSEDR01DDDRImpedance -Vlead589Ω -Alead343ΩApacingthreshold -1.8V0.5msVpacingthreshold -1.6V0.5msRwave 8.8mvPwave 3.4mv

Paradoxicalseptalmotion,LVEDD2.1cm,FS25.3%,LVEF58%3daysafterRVpacing

ECHOpostDDDpacing:ECHObeforeDDDpacing:

PericardialeffusionShortaxisviewLongaxisviewDay12postpacingSurgicaldrainageofpericardialfluid(30cc)

LVEDD2.76cm,FS14.6%,EF37.8%DilatedLVcavity3weekspostpacingDischargefromhospitalwithdiureticsPacingrate70-180/min

3.5monthspostRVpacing Significantheartfailuresymptom:tachypneaandfluidretentionEcho -dilatedLV,LVEDD3.3cm -ModeratetricuspidandmitralincompetencePoorLVcontraction,LVFS5%LVEF14.3%ECGshowedirregularrhythm,WenckebachphenomenonduetorapidatrialratewhileonDDDpacingPacemodechangedtoVVI130/minHospitalizedfordobutamineinfusion

ECHOprogressiveLVdilatation

SevereLVdysynchrony,LVPW–Septaldelay255ms

3daysafteradmissionWhenVVIturnedoff?intrinsicesc