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一例左心导管插入术期间的短暂性完全性心脏传导阻滞病例。

A Case of Transient Complete Heart Block During Left Heart Catheterization.

作者信息

Koirala Sushant, Qarajeh Raed, Collado Fareed

机构信息

Internal Medicine, Rush University Medical Center, Chicago, USA.

Medicine/Cardiology, Rush University Medical Center, Chicago, USA.

出版信息

Cureus. 2024 Jun 11;16(6):e62161. doi: 10.7759/cureus.62161. eCollection 2024 Jun.

DOI:10.7759/cureus.62161
PMID:38993462
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11238658/
Abstract

Iatrogenic complete heart blocks are rare but a reported complication of left heart catheterizations in patients with pre-existing right bundle branch blocks. We present the case of an 84-year-old male with a preexisting right bundle branch block who underwent a left heart catheterization for valve replacement evaluation. While attempting to engage the right coronary artery, the catheter instead crossed the aortic valve, causing the patient to become bradycardic to the 20s and hypotensive. The patient had a temporary transvenous pacer inserted and tolerated the rest of the procedure well. The cause of the complete heart block was thought to be due to the transient blockage of the left bundle branch due to ventricular septal irritation when the catheter crossed the aortic valve. When performing left heart angiograms in a patient with a right bundle branch block, operators should be prepared for a possible iatrogenic complete heart block.

摘要

医源性完全性心脏传导阻滞很少见，但据报道是已有右束支传导阻滞患者左心导管插入术的一种并发症。我们报告了一例84岁男性患者，该患者已有右束支传导阻滞，因评估瓣膜置换而接受左心导管插入术。在试图进入右冠状动脉时，导管反而穿过了主动脉瓣，导致患者心率降至20多次/分钟且血压降低。患者插入了临时经静脉起搏器，其余手术过程耐受良好。完全性心脏传导阻滞的原因被认为是导管穿过主动脉瓣时，室间隔受到刺激导致左束支短暂阻塞。在对右束支传导阻滞患者进行左心造影时，操作人员应做好可能发生医源性完全性心脏传导阻滞的准备。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/943a/11238658/c4d1a31c4454/cureus-0016-00000062161-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/943a/11238658/652a9beeb9e9/cureus-0016-00000062161-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/943a/11238658/2addd866bdb2/cureus-0016-00000062161-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/943a/11238658/3fb1b7a872d0/cureus-0016-00000062161-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/943a/11238658/c4d1a31c4454/cureus-0016-00000062161-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/943a/11238658/652a9beeb9e9/cureus-0016-00000062161-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/943a/11238658/2addd866bdb2/cureus-0016-00000062161-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/943a/11238658/3fb1b7a872d0/cureus-0016-00000062161-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/943a/11238658/c4d1a31c4454/cureus-0016-00000062161-i04.jpg

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本文引用的文献

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Prog Cardiovasc Dis. 2021 May-Jun;66:37-45. doi: 10.1016/j.pcad.2021.06.004.
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Conduction disturbances after TAVR: Electrophysiological studies and pacemaker dependency.经导管主动脉瓣置换术后的传导障碍：电生理研究与起搏器依赖
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Iatrogenic Transient Complete Heart Block in a Preexisting LBBB.既往存在左束支传导阻滞时的医源性短暂完全性心脏传导阻滞
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