He Chuan, Zhou Yang, Tang Si-Si, Luo Li-Hong, Feng Kun
Department of Cardiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China.
World J Clin Cases. 2020 Nov 26;8(22):5715-5721. doi: 10.12998/wjcc.v8.i22.5715.
An atrial septal defect is a common condition and accounts for 25% of adult congenital heart diseases. Transcatheter occlusion is a widely used technique for the treatment of secondary aperture-type atrial septal defects (ASDs).
A 30-year-old female patient was diagnosed with ASD by transthoracic echocardiography (TTE) 1 year ago. The electrocardiogram showed a heart rate of 88 beats per minute, normal sinus rhythm, and no change in the ST-T wave. After admission, TTE showed an atrial septal defect with a left-to-right shunt, aortic root short-axis section with an ASD diameter of 8 mm, a parasternal four-chamber section with an ASD diameter of 9 mm, and subxiphoid biatrial section with a diameter of 13 mm. Percutaneous occlusion was proposed. The intraoperative TTE scan showed that the atrial septal defect was oval in shape, was located near the root of the aorta, and had a maximum diameter of 13 mm. A 10-F sheath was placed in the right femoral vein, and a 0.035° hard guidewire was used to establish the transport track between the left pulmonary vein and the inferior vena cava. A shape-memory alloy atrial septal occluder with a waist diameter of 20 mm was placed successfully and located correctly. TTE showed that the double disk unfolded well and that the clamping of the atrial septum was smooth. Immediately after the disc was revealed, electrocardiograph monitoring showed that the ST interval of the inferior leads was prolonged, the P waves and QRS waves were separated, a junctional escape rhythm maintained the heart rate, and the blood pressure began to decrease. After removing the occluder, the elevation in the ST segment returned to normal immediately, and the sinus rhythm returned to average approximately 10 min later. After consulting the patient's family, we finally decided to withdraw from the operation.
Compression of the small coronary artery, which provides an alternative blood supply to the atrioventricular nodule during the operation, leads to the emergence of a complete atrioventricular block.
房间隔缺损是一种常见病症，占成人先天性心脏病的25%。经导管封堵术是治疗继发孔型房间隔缺损（ASD）广泛应用的技术。
一名30岁女性患者1年前经胸超声心动图（TTE）诊断为房间隔缺损。心电图显示心率88次/分钟，窦性心律正常，ST - T波无变化。入院后，TTE显示房间隔缺损伴左向右分流，主动脉根部短轴切面房间隔缺损直径8 mm，胸骨旁四腔切面房间隔缺损直径9 mm，剑突下双房切面直径13 mm。建议行经皮封堵术。术中TTE扫描显示房间隔缺损呈椭圆形，位于主动脉根部附近，最大直径13 mm。在右股静脉置入10 - F鞘管，使用0.035°硬导丝在左肺静脉和下腔静脉之间建立输送轨道。成功置入一枚腰径20 mm的记忆合金房间隔封堵器并定位正确。TTE显示双盘展开良好，房间隔夹闭顺畅。封堵器释放后即刻，心电图监测显示下壁导联ST段延长，P波与QRS波分离，交界性逸搏心律维持心率，血压开始下降。取出封堵器后，ST段抬高立即恢复正常，约10分钟后窦性心律恢复。与患者家属沟通后，我们最终决定取消手术。
术中对为房室结提供替代血供的小冠状动脉的压迫导致完全性房室传导阻滞的出现。
