Gupta Nikhil, Moore Jeremy P, Shannon Kevin
J Interv Card Electrophysiol. 2012 Oct;35(1):115-8. doi: 10.1007/s10840-012-9682-5. Epub 2012 May 4.
We describe two patients with congenital heart disease who were referred for implantable cardioverter-defibrillator (ICD) placement. Both patients possessed factors causing the conventional transvenous approach to be undesirable. We therefore devised a technique which circumvented both intravascular ICD lead placement, as well as placement of leads across the tricuspid valve.
For both patients, a bipolar pace-sense lead was successfully placed in a branch of the coronary sinus. A shocking coil was then tunneled from the posterolateral margin of the device pocket, being positioned posterior and inferior to the cardiac silhouette. Defibrillation testing was carried out with goal of a 10-J safety margin.
We were able to successfully achieve ICD implantation in both patients with complex congenital heart disease without requirement for surgical thoracotomy or a lead across the AV valve. R waves in excess of 5 mV were obtained and acceptable defibrillation characteristics were achieved. Both patients are doing well after mid-term follow-up.
A new implant approach is presented, which involves minimal intravascular hardware and eliminates passage across the atrioventricular valve for patients with congenital heart disease in whom conventional ICD implant techniques may be undesirable or not possible. This procedure is technically straightforward with proper technique and knowledge of the patient specific anatomy.
我们描述了两名因植入式心脏复律除颤器（ICD）植入而前来就诊的先天性心脏病患者。两名患者均存在一些因素，使得传统的经静脉途径不可行。因此，我们设计了一种技术，该技术既避免了血管内ICD导线的放置，也避免了导线穿过三尖瓣。
对于这两名患者，均成功地将一根双极起搏感知导线放置在冠状窦的一个分支中。然后，一个电击线圈从设备袋的后外侧边缘穿出，置于心脏轮廓后方和下方。进行除颤测试，目标是达到10焦耳的安全裕度。
我们成功地为两名患有复杂先天性心脏病的患者植入了ICD，无需进行开胸手术或穿过房室瓣放置导线。获得了超过5毫伏的R波，并实现了可接受的除颤特性。两名患者在中期随访后情况良好。
提出了一种新的植入方法，该方法涉及最少的血管内硬件，并避免了对于传统ICD植入技术可能不可行或无法实施的先天性心脏病患者穿过房室瓣。该手术在技术上很简单，只要有适当的技术并了解患者的具体解剖结构即可。
