靠右心室起搏的嬰兒產(chǎn)生了雙心室起搏由此導(dǎo)致了心力衰竭病例英文PPT課件

1、Male babylAntenatallat 21 week of gestation noted have bradycardia and AV blocklmother anti Ro, RF + ve lLSCS at 35 weeks for progressive fetal heart failure, birth weight 2.36 kglPost-natal lRespiratory distresslCXR : cardiomegaly, CT ratio 67% lPut on nasal CPAP + Isoprenaline infusion第1頁/共30頁第2頁/

2、共30頁CT ratio 67%第3頁/共30頁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第4頁/共30頁 Epicardial pacemaker insertion the second day after admission RA RV (inferior wall) pacing DDD (

3、90-180/min)Post epicardial DDD pacing: CT ratio 67.9%第5頁/共30頁Measurement at Operation Leads 4965 steroid-eluted leads for both RA and RV Generator-Sensia SE DR 01 DDDR Impedance - V lead 589 - A lead 343 A pacing threshold - 1.8V 0.5ms V pacing threshold - 1.6V 0.5ms R wave 8.8mv P wave 3.4mv第6頁/共30

4、頁P(yáng)aradoxical septal motion, LVEDD 2.1cm, FS 25.3% , LVEF 58%3 days after RV pacing第7頁/共30頁ECHO post DDD pacing:ECHO before DDD pacing:第8頁/共30頁第9頁/共30頁P(yáng)ericardial effusion Short axis viewLong axis viewDay 12 post pacing Surgical drainage of pericardial fluid (30cc)第10頁/共30頁LVEDD 2.76cm, FS 14.6%, EF

5、37.8% Dilated LV cavity3 weeks post pacingDischarge from hospital with diuretics Pacing rate 70-180/min第11頁/共30頁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

6、 , 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 第12頁/共30頁ECHO progressive LV dilatation第13頁/共30頁 Severe LV dysynchrony, LVPW Septal delay 255ms第14頁/共30頁3 day

7、s 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/minPlan Bive

8、ntricular epicardial pacing第15頁/共30頁- LV epicardial pacing - LV lead threshold = 1.0 v , 0.4ms- RV/LV delay = 4ms (LV first)第16頁/共30頁1 day after biventricular pacing第17頁/共30頁P(yáng)ost bivent pacingLVPW Septal delay 65msDDD RV pacing LVPW Septal delay 255msSecond day post biventricular pacingLVEDD 3.24cm,

9、 LVSF 20.6%, mild mitral incompetence第18頁/共30頁 Second day post biventricular pacing Sense AV intervals VTI of LVOT50ms8.380ms9.1100ms9.1120ms8.5140ms5.8 V-V delay LV first VTI of LVOT (sense AV 100ms) 4 ms7.812ms7.520ms6.8 40ms7.5第19頁/共30頁Biventricular pacing QRD duration: 100 ms 第20頁/共30頁P(yáng)ost epica

10、rdial DDD (RA RV ) pacing 90 -180 ppm QRS duration 120 ms第21頁/共30頁DDD RV pacing QRS duration: 120 msBiventricular pacing QRD duration: 100 ms 第22頁/共30頁1 week after Bivent pacing Home with diuretics and ACEILVEDD 3.19cm, LVSF 20.2% LVEF 49.3%Septal-LVPW delay 65ms10 days after Bivent pacing LVEDD 3.0

11、2cm, LVSF 26.7%, LVEF 60.0%17 days after Bivent pacing LVEDD 2.51cm, LVSF 27.8% ,LVEF 62.5%4 weeks post Bivent pacingLVEDD 2.4cm, LVSF 33% LVEF 69.9%第23頁/共30頁3 weeks after Bivent pacing5 months post Bivent pacingLVEDD 2.5cm, LVSF 44% , LVEF 82%no mitral incompetenceOff medication第24頁/共30頁 9 months p

12、ost biventrcular pacing LVEDD 2.32cm, FS 32.5% LVEF 67.2%第25頁/共30頁LV size and LV ejection fractioncmBivent pacingAdmission for heart failure第26頁/共30頁Summary: RV pacing may occasionally induced severe LV dysfunction secondary to LV dysynchrony LV dysfunction may be evident within 2 weeks after RV pacing and progress to dilated cardiomyopathy Biventricular pacing (CRT) can correct the LV dysynchrony and the dilated cardiomyopathy 第27頁/共30頁