Wang Yefeng, Liu Qiming, Deng Xicheng, Xiao Yunbin, Chen Zhi
Department of Cardiology, Hunan Children's Hospital.
Department of Cardiology, Second Xiangya Hospital, Central South University.
Medicine (Baltimore). 2019 Feb;98(6):e14320. doi: 10.1097/MD.0000000000014320.
Atrioventricular reentrant tachycardia (AVRT) is the most common supraventricular tachycardia occurring in children. However, in complex congenital heart disease patients with a different heart anatomy and conduction system morphology, accessory pathway modification may be particularly challenging because of distortion of typical anatomic landmarks.
A 10-year-old boy with tricuspid atresia and history of bidirectional Glenn operation had recurrent chest distress and palpitation for 3 months. He had multiple hospitalizations for narrow-QRS tachycardia with poor hemodynamic tolerance, despite the use of adenosine and amiodarone.
AVRT. Tricuspid atresia with secundum atrial septal defect, large ventricular septal defect, and right ventricular outflow tract stenosis.
Cardiac catheterization, electrophysiological examination, and ablation.
The child has not had a recurrent AVRT during 6 months of follow-up and is waiting for Fontan operation.
Since there is an increased risk of accessory pathways in patients with tricuspid atresia, all these patients should be checked before the Fontan operation to exclude congenital accessory pathways.
房室折返性心动过速（AVRT）是儿童最常见的室上性心动过速。然而，在心脏解剖结构和传导系统形态不同的复杂先天性心脏病患者中，由于典型解剖标志的扭曲，附加径路改良可能特别具有挑战性。
一名10岁男孩，患有三尖瓣闭锁，有双向格林手术史，反复出现胸部不适和心悸3个月。尽管使用了腺苷和胺碘酮，他仍因窄QRS心动过速多次住院，血流动力学耐受性差。
AVRT。三尖瓣闭锁合并继发孔房间隔缺损、大型室间隔缺损和右心室流出道狭窄。
心导管检查、电生理检查和消融。
该患儿在随访6个月期间未再发生AVRT，正在等待Fontan手术。
由于三尖瓣闭锁患者存在附加径路的风险增加，所有这些患者在Fontan手术前都应进行检查，以排除先天性附加径路。
