靠右心室起搏的婴儿产生了双心室起搏-由此导致了心力衰竭-病例(英文).ppt

按一下以編輯母片標題樣式,按一下以編輯母片,第二層,第三層,第四層,第五層,*,TC Yung,Paediatric Cardiology Unit,Grantham Hospital,Hong Kong,Biventricular pacing in a baby with RV pacing induced heart failure,The 10th South China International Congress of Cardiology,Guangzhou,2008,Male baby,Antenatal,at 21 week of gestation noted have,bradycardia,and AV block,mother anti Ro,RF+,ve,LSCS at 35 weeks for progressive fetal heart failure,birth weight 2.36 kg,Post-natal,Respiratory distress,CXR:,cardiomegaly,CT ratio 67%,Put on nasal CPAP+,Isoprenaline,infusion,CT ratio 67%,Epicardial pacemaker insertion the second day after admission,RA RV(inferior wall)pacing DDD(90-180/min),Post epicardial DDD pacing:CT ratio 67.9%,Measurement at Operation,Leads 4965 steroid-eluted leads for both RA and RV,Generator-Sensia SE DR 01 DDDR,Impedance -V lead 589,-A lead 343,A pacing threshold-1.8V 0.5ms,V pacing threshold-1.6V 0.5ms,R wave8.8mv,P wave3.4mv,Paradoxical septal motion,LVEDD 2.1cm,FS 25.3%,LVEF 58%,3 days after RV pacing,Pericardial effusion,Short axis view,Long axis view,Day 12 post pacing,Surgical drainage of pericardial fluid (30cc),3.5 months post RV pacing,Significant heart failure symptom:tachypnea and fluid retention,Echo-dilated LV,LVEDD 3.3 cm,-Moderate tricuspid and mitral incompetence,Poor LV contraction,LVFS 5%LVEF 14.3%,ECG showed irregular rhythm,Wenckebach,phenomenon due to,rapid,atrial,rate while on DDD pacing,Pace mode changed to VVI 130/min,Hospitalized for,dobutamine,infusion,Severe LV dysynchrony,LVPW Septal delay 255ms,3 days after admission,When VVI turned off,intrinsic escape rhythm,s,ynchronized LV contraction,pacing rate to 55/min and started isoprenaline to promote synchronized contraction,But heart failure continued to deteriorate,The baby was intubated for 5 days,RV pacing rate was increased to 120/min,Plan,Biventricular epicardial pacing,1 day after biventricular pacing,Post bivent pacing,LVPW Septal delay 65ms,DDD RV pacing,LVPW Septal delay 255ms,Second day post biventricular pacing,LVEDD 3.24cm,LVSF 20.6%,mild mitral incompetence,Second day post biventricular pacing,Sense AV intervals VTI of LVOT,50ms8.3,80ms9.1,100ms9.1,120ms8.5,140ms5.8,V-V delay,LV first,VTI of LVOT,(sense AV 100ms),4 ms7.8,12ms7.5,20ms6.8,40ms7.5,Biventricular pacing QRD duration:100 ms,Post epicardial DDD(RA RV)pacing 90-180 ppm,QRS duration 120 ms,1 week after Bivent pacing,Home with diuretics and ACEI,LVEDD 3.19cm,LVSF 20.2%LVEF 49.3%,Septal-LVPW delay 65ms,10 days after Bivent pacing,LVEDD 3.02cm,LVSF 26.7%,LVEF 60.0%,17 days after Bivent pacing,LVEDD 2.51cm,LVSF 27.8%,LVEF 62.5%,4 weeks post Bivent pacing,LVEDD 2.4cm,LVSF 33%LVEF 69.9%,3 weeks after Bivent pacing,5 months post Bivent pacing,LVEDD 2.5cm,LVSF 44%,LVEF 82%,no mitral incompetence,Off medication,9 months post biventrcular pacing,LVEDD 2.32cm,FS 32.5%LVEF 67.2%,Summary:,RV pacing may occasionally induced severe LV dysfunction secondary to LV,dysynchrony,LV dysfunction may be evident within 2 weeks after RV pacing and progress to dilated,cardiomyopathy,Biventricular pacing(CRT)can correct the LV,dysynchrony,and the dilated,cardiomyopathy,Post epicardial DDD(RA RV)pacing 90-180 ppm,QRS duration 120 ms,