Tanaka Hiroyuki, Okishige Kaoru, Murakami Mikiko, Someya Takeshi, Arai Hirokuni, Sunamori Makoto
Department of Thoracic and Cardiovascular Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-0034, Japan.
Jpn J Thorac Cardiovasc Surg. 2002 Jul;50(7):290-3. doi: 10.1007/BF03032297.
We report a case of dilated cardiomyopathy with severe congestive heart failure (ejection fraction: 19%) and complete left bundle branch block (QRS duration: 240 ms) 13 years after aortic valve replacement. Permanent biventricular pacing was implanted by inserting a left ventricular lead thorough a small left thoracotomy following intravenous insertion of right atrial and ventricular endocardial leads. Biventricular pacing increased hemodynamic parameters such as blood pressure, cardiac output and decreased mitral regurgitation. Symptoms and exercise tolerance improved dramatically. Left ventricular epicardial lead insertion via a small thoracotomy is thus useful in selected patients.
我们报告一例主动脉瓣置换术后13年出现扩张型心肌病伴严重充血性心力衰竭（射血分数：19%）和完全性左束支传导阻滞（QRS时限：240毫秒）的病例。在经静脉插入右心房和心室心内膜导线后，通过左胸小切口插入左心室导线，植入永久性双心室起搏器。双心室起搏增加了诸如血压、心输出量等血流动力学参数，并减少了二尖瓣反流。症状和运动耐量显著改善。因此，经小切口插入左心室心外膜导线对选定患者是有用的。
