Feins Eric N, O'Leary Edward T, Hoganson David M, Schulz Noah, Eickoff Emily, Davee Jocelyn, Triedman John K, Baird Christopher W, Del Nido Pedro J, Emani Sitaram, DeWitt Elizabeth S
Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
JTCVS Tech. 2022 Feb 1;12:159-163. doi: 10.1016/j.xjtc.2021.11.017. eCollection 2022 Apr.
Postoperative heart block is a significant problem in congenital heart surgery because of the unpredictability and variability of conduction tissue location in complex congenital heart defects. A novel technique for intraoperative conduction system mapping during complex congenital heart surgery is described.
Intraoperative conduction system mapping was performed utilizing a high-density multielectrode grid catheter to collect intracardiac electrograms on open, beating hearts during repair of complex congenital heart defects. Electrograms were interpreted by electrophysiologists, and conduction tissue location was communicated in real time to the surgeon. After localizing conduction tissue, the heart was arrested and the repair was completed taking care to avoid injury to the mapped conduction system.
Two patients with complex heterotaxy syndrome underwent intraoperative conduction mapping during biventricular repair. Mapping accurately identified the location of conduction tissue thereby enabling avoidance of conduction system injury during surgery. Notably, conduction was unexpectedly found to be located inferiorly in a patient with L-looped ventricles. Successful biventricular repair was accomplished in both patients without injury to the conduction system.
Intraoperative conduction mapping can effectively localize the conduction system during surgery and enable the surgeon to avoid its injury. This can lower the risk of heart block requiring pacemaker in children undergoing complex congenital heart surgery.
由于复杂先天性心脏缺陷中传导组织位置的不可预测性和变异性，术后心脏传导阻滞是先天性心脏手术中的一个重大问题。本文描述了一种在复杂先天性心脏手术中进行术中传导系统标测的新技术。
在复杂先天性心脏缺陷修复过程中，利用高密度多电极格栅导管在开放、跳动的心脏上进行术中传导系统标测，以收集心内电图。电生理学家解读电图，并将传导组织位置实时告知外科医生。在定位传导组织后，心脏停搏，完成修复，同时注意避免损伤已标测的传导系统。
两名患有复杂异构综合征的患者在双心室修复过程中接受了术中传导标测。标测准确地确定了传导组织的位置，从而在手术中避免了传导系统损伤。值得注意的是，在一名L型心室患者中，意外发现传导组织位于下方。两名患者均成功完成双心室修复，且传导系统未受损伤。
术中传导标测可在手术过程中有效地定位传导系统，并使外科医生避免对其造成损伤。这可以降低接受复杂先天性心脏手术的儿童发生需要起搏器治疗的心脏传导阻滞的风险。
