Wong Dennis T L, Leong Darryl P, Khurana Suchi, Puri Rishi, Tayeb Hussam, Sanders Prashanthan
Cardiovascular Research Centre, Adelaide, Australia.
BMJ Case Rep. 2010 Nov 2;2010:bcr1220092524. doi: 10.1136/bcr.12.2009.2524.
A 75-year-old man with history of paroxysmal atrial fibrillation developed acute pulmonary oedema immediately after permanent pacemaker insertion for symptomatic bradycardia and was transferred to our institution. Echocardiography prior to pacemaker insertion showed normal left ventricle (LV) function and mild mitral regurgitation (MR). A single-chamber pacemaker had been inserted with the ventricular lead positioned in the right ventricular apex. He was treated with diuretics with symptomatic improvement. Investigations failed to reveal a cause for cardiac failure. Patient subsequently had multiple readmissions for heart failure and echocardiography revealed severe MR. Patient was referred for mitral valve (MV) surgery. Intraoperatively, when patient was in sinus rhythm and not paced, transoesophageal echocardiogram showed a significant reduction in the severity of MR. MV surgery was aborted and further echocardiographic characterisation revealed worsening of MR during ventricular pacing. The device was upgraded to a dual-chamber system and programmed to atrial pacing with intrinsic ventricular rhythm. He has had no further admissions over the following year.
一名75岁阵发性心房颤动患者，因症状性心动过缓植入永久性起搏器后立即发生急性肺水肿，随后被转至我院。起搏器植入前的超声心动图显示左心室（LV）功能正常，轻度二尖瓣反流（MR）。已植入单腔起搏器，心室导线置于右心室心尖部。给予利尿剂治疗后症状改善。检查未能发现心力衰竭的病因。患者随后因心力衰竭多次入院，超声心动图显示重度MR。患者被转诊进行二尖瓣（MV）手术。术中，当患者处于窦性心律且未起搏时，经食管超声心动图显示MR严重程度显著降低。MV手术中止，进一步的超声心动图检查显示心室起搏期间MR恶化。该装置升级为双腔系统，并程控为心房起搏伴自身心室节律。在接下来的一年里，他没有再次入院。
