Bryant Roosevelt, Aboutalebi Amir, Kim Jeffrey J, Kertesz Naomi, Morales David L S
Department of Congenital Heart Surgery, Texas Children's Hospital, Houston, TX 77030, USA.
Tex Heart Inst J. 2011;38(4):421-3.
Implantable cardioverter-defibrillators have aided the prevention of sudden cardiac death in adults. The hope is to provide similar benefits to the pediatric population as the devices become smaller. Herein, we present the case of a 4.9-kg, 5-week-old infant boy who presented with cardiopulmonary arrest. After emergency defibrillation, conventional treatment options included long-term hospitalization for later cardioverter-defibrillator implantation, or installation of an external defibrillator with subsequent home telemetry. On the basis of the infant's body dimensions, we decided that an epicardial implantable cardioverter-defibrillator was feasible and the best option. We performed a median sternotomy and placed a Vitality® implantable cardioverter-defibrillator with a 25-cm defibrillator coil and a 35-cm bipolar ventricular lead. The patient experienced no postoperative morbidity or rhythm disturbances and was discharged from the hospital on postoperative day 5. He was placed on β-blocker therapy and has remained well for 3 years.Although external devices can be placed in a small patient, we believe that they are too susceptible to lead damage and lead migration, and that the defibrillator thresholds are less reliable. We think that dysrhythmias even in very small children can be treated effectively and safely with use of an epicardial implantable cardioverter-defibrillator. To our knowledge, this 4.9-kg infant is the smallest patient to have undergone a successful implantation of this kind.
植入式心脏复律除颤器有助于预防成人的心源性猝死。随着设备体积变小，人们希望能为儿科患者带来类似的益处。在此，我们报告一例体重4.9千克、5周大的男婴，该患儿出现心肺骤停。紧急除颤后，常规治疗方案包括长期住院以便后期植入心脏复律除颤器，或安装体外除颤器并随后进行家庭远程监测。根据婴儿的身体尺寸，我们认为植入式心外膜心脏复律除颤器是可行的且是最佳选择。我们进行了正中胸骨切开术，并植入了一台带有25厘米除颤线圈和35厘米双极心室导线的Vitality®植入式心脏复律除颤器。患者术后未出现并发症或心律失常，术后第5天出院。他接受了β受体阻滞剂治疗，3年来情况良好。尽管可以为小患者放置体外设备，但我们认为它们极易发生导线损坏和导线移位，而且除颤阈值不太可靠。我们认为，即使是非常小的儿童，使用植入式心外膜心脏复律除颤器也能有效且安全地治疗心律失常。据我们所知，这位体重4.9千克的婴儿是成功接受此类植入手术的最小患者。
