Robledo Nolasco Rogelio, Buenfil Medina José Carlos, Soto Solís Jaime, Juárez Pelcastre Neil, Zaragoza Rodríguez Gregorio, Flores Flores Jesús, Sánchez Pazaran José Luis, Blanco Canto Mario, Cortés García Alejandro, Reyes Barrera Vidal Efrén, Padilla Parga Carlos Enrique
Servicio de Hemodinamia y Electrofisiología Clínica. CMN 20 de Noviembre del ISSSTE, México, D.F.
Arch Cardiol Mex. 2002 Jul-Sep;72(3):233-9.
One of the complications of tricuspid valve replacement (TVR) is the complete heart block (CHB). In these patients an epicardial permanent pacemaker is frequently used but its insertion is another major operation and higher thresholds are needed. Two patients are reported, both women, with rheumatic heart disease and TVR who required a permanent pacemaker because they developed CHB. The first patient underwent mitral valve replacement with a disc valve seventeen years before and TVR recently. A single chamber pacemaker was implanted. Left ventricular pacing was achieved through the great cardiac vein. The acute and chronic pacing thresholds were adequate. The second patient underwent tricuspid and mitral replacement with a Starr-Edwards (SE) valve. Eighteen years later this patient had atrial fibrillation with slow ventricular response and heart failure. The pacemaker lead had to be inserted across the tricuspid SE valve because ventricle pacing through the coronary veins was unsuccessful. The endocardial pacing resulted in mild tricuspid regurgitation and has continued the same way for four years. To conclude, ventricle pacing through the coronary veins is safe, produces excellent results and fewer complications. On the other hand, ventricle pacing across a prosthetic tricuspid valve remains questionable because of possible damage to the prosthesis itself leading to valve insufficiency and because of damage to the pacing lead.
三尖瓣置换术（TVR）的并发症之一是完全性心脏传导阻滞（CHB）。在这些患者中，经常使用心外膜永久起搏器，但其植入是另一项大手术，且需要更高的起搏阈值。本文报告了两名患有风湿性心脏病并接受TVR的女性患者，她们因发生CHB而需要永久起搏器。第一名患者17年前接受了带瓣二尖瓣置换术，最近接受了TVR。植入了单腔起搏器。通过大心静脉实现左心室起搏。急性和慢性起搏阈值均合适。第二名患者接受了用Starr-Edwards（SE）瓣膜进行的三尖瓣和二尖瓣置换术。18年后，该患者出现房颤伴缓慢心室反应和心力衰竭。由于经冠状静脉进行心室起搏未成功，起搏器导线不得不穿过三尖瓣SE瓣膜插入。心内膜起搏导致轻度三尖瓣反流，且这种情况持续了四年。总之，经冠状静脉进行心室起搏是安全的，效果良好且并发症较少。另一方面，穿过人工三尖瓣进行心室起搏仍存在疑问，因为可能会损坏假体本身导致瓣膜功能不全，也因为会损坏起搏导线。
