Glatz Andrew C, McBride Michael G, Paridon Stephen M, Cohen Meryl S, Walker Susan A, Gaynor J William, Tanel Ronn E
Department of Pediatrics, Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Congenit Heart Dis. 2010 Mar-Apr;5(2):141-8. doi: 10.1111/j.1747-0803.2010.00388.x.
The sinus venosus atrial septal defect (SVASD) has been successfully repaired with low risk for many years. Postoperative arrhythmias have not been comprehensively described. We sought to define the prevalence of late arrhythmias after surgical closure of the SVASD.
We performed a cross-sectional noninvasive arrhythmia evaluation of patients > or =6 years of age, who had surgical repair of an isolated SVASD at a single institution from 1987 to 2004, to assess for sinus node dysfunction (SND), atrioventricular (AV) block, and atrial and ventricular arrhythmias. Evaluation included an electrocardiogram, echocardiogram, 24-hour Holter monitor, and exercise stress test.
Thirty subjects were evaluated 10.1 +/- 4.7 years (range 3.3-20.4 years) after operative repair. Mean age at surgical repair was 6.4 +/- 8.1 years (range 1.3-45.7 years). Anatomic subtype was either superior vena cava- (SVC) (n = 24) or inferior vena cava- (IVC) type (n = 6). Type of surgical repair included: single patch (n = 13), double patch (n = 6), and Warden (n = 5) for SVC-type. All IVC-type had single patch repair. Overall, 50% (n = 15) of patients showed some evidence of SND, which is significantly associated with a longer duration of follow-up (P= .03). High-grade AV block and complex tachyarrhythmias were not seen.
We conclude that postoperative SVASD patients have a significant prevalence of SND, which may increase with duration of follow-up. These patients warrant ongoing clinical surveillance for the potential development of signs and symptoms of SND.
多年来，静脉窦型房间隔缺损（SVASD）已成功修复，风险较低。术后心律失常尚未得到全面描述。我们试图确定SVASD手术闭合术后晚期心律失常的发生率。
我们对1987年至2004年在单一机构接受孤立性SVASD手术修复的≥6岁患者进行了横断面无创心律失常评估，以评估窦房结功能障碍（SND）、房室（AV）传导阻滞以及房性和室性心律失常。评估包括心电图、超声心动图、24小时动态心电图监测和运动负荷试验。
30名受试者在手术修复后10.1±4.7年（范围3.3 - 20.4年）接受评估。手术修复时的平均年龄为6.4±8.1岁（范围1.3 - 45.7岁）。解剖亚型为上腔静脉（SVC）型（n = 24）或下腔静脉（IVC）型（n = 6）。SVC型的手术修复类型包括：单片修补（n = 13）、双片修补（n = 6）和沃登修补术（n = 5）。所有IVC型均采用单片修补。总体而言，50%（n = 15）的患者有SND的某些证据，这与更长的随访时间显著相关（P = .03）。未发现高度AV传导阻滞和复杂性快速心律失常。
我们得出结论，SVASD术后患者SND的发生率较高，且可能随随访时间延长而增加。这些患者有必要持续接受临床监测，以观察SND体征和症状的潜在发展。
