Hamilton S D, Bartley T D, Miller R H, Schiebler G L, Marriott H J
Departments of Surgery, Pediatrics, and the Human Development Center, University of Florida College of Medicine, Gainesville, Florida, USA.
Circulation. 1968 Jul;38(1):73-81. doi: 10.1161/01.cir.38.1.73.
Disturbances in atrial conduction or rhythm, or both, were found in 16 of 27 patients undergoing the surgical creation of an atrial septal defect by the Blalock-Hanlon technique. These included P-wave aberrations of intra-atrial block and ectopic atrial rhythm, A-V rhythm, A-V dissociation, sinus bradycardia, atrial flutter, escape-capture bigeminy, and atrial premature beats. Some of these were transient and occurred within 2 weeks after surgery. It seems likely that tissue trauma engendered by the clamp and resection of the atrial septum with possible injury to the internodal conducting pathways may be the genesis of these early postoperative disturbances. Of the eight cases with transient disturbances, six occurred in this period. Later changes, such as intra-atrial block, sinus bradycardia, and atrial flutter, may be attributed to changes in atrial size secondary to the postoperative pathophysiology. Digitalis intoxication and congestive heart failure cannot be excluded as contributory factors in either the early or the late disturbances. It was not possible to correlate the incidence and nature of these disturbances with morbidity and mortality. In such severely ill, cyanotic infants, irregularities, however slight, may have altered cardiac function significantly and contributed to their deaths.
在27例采用布莱洛克 - 汉隆技术进行房间隔缺损手术的患者中，有16例出现了心房传导或节律紊乱，或两者皆有。这些情况包括房内阻滞的P波异常、异位心律、房室节律、房室分离、窦性心动过缓、心房扑动、逸搏 - 夺获二联律和房性早搏。其中一些是短暂性的，发生在术后2周内。钳夹和切除房间隔可能对结间传导通路造成损伤，由此产生的组织创伤似乎可能是这些术后早期紊乱的根源。在8例有短暂性紊乱的病例中，有6例发生在这一时期。后期变化，如房内阻滞、窦性心动过缓及心房扑动，可能归因于术后病理生理改变导致的心房大小变化。洋地黄中毒和充血性心力衰竭不能排除为早期或晚期紊乱的促成因素。无法将这些紊乱的发生率和性质与发病率及死亡率联系起来。在这类病情严重的青紫型婴儿中，无论多么轻微的心律不齐，都可能显著改变心脏功能并导致其死亡。
