经永存左上腔静脉植入起搏电极体会Clinical experience of pacemaker lead implantation through persistent left superior vena cava
王禹川,丁燕生,周菁,盛琴慧,蒋捷,陈学智
摘要(Abstract)：
目的总结经永存左上腔静脉(PLSVC)植入起搏电极体会。方法总结4例PLSVC植入双腔起搏器的患者。患者出院前及出院后3个月、6个月进行随访,了解起搏器工作状态。结果4例患者术前均常规行经胸超声心动图检查,结果显示冠状静脉窦开口扩大,提示PLSVC存在可能。第1例患者因术前发现PLSVC可能,首先穿刺右侧锁骨下静脉;造影显示右上腔静脉缺如,右侧锁骨下静脉汇入PLSVC。第2、3例患者因双腔起搏器植入前反复出现心动过缓相关症状,在术前经右侧锁骨下静脉植入临时起搏器,术中造影显示PLSVC与右侧上腔静脉无交通。第4例患者在置入导丝时直接经PLSVC进入右心房。患者术后3个月、6个月常规行起搏器程控并调整起搏器出厂设置参数,此后每6~12个月行起搏器程控,程控时测量心房电极和心室电极的起搏阈值、感知和阻抗,均在满意范围。第1例患者两次随访时心律均为窦性心律,心房电极感知大于2 mV,起搏阈值小于1 V,阻抗小于1000Ω。结论 PLSVC能够顺利完成起搏电极植入。
关键词(KeyWords)： 永存左上腔静脉;起搏电极
基金项目(Foundation):
作者(Author): 王禹川,丁燕生,周菁,盛琴慧,蒋捷,陈学智
参考文献(References)：
- [1]Paval J,Nayak S.A persistent left superior vena cava.Singapore Med J,2007,48:e90-e93.
- [2]Imran N,Grubb B,Kanjwal Y.Persistent left superior vena cava:a blessing in disguise.Europace,2008,10:588-590.
- [3]Povoski SP,Khabiri H.Persistent left superior vena cava:review of the literature,clinical implications,and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients.World J Surg Oncol,2011,28:173.
- [4]Peltier J,Destrieux C,Desme J,et al.The persistent left superior vena cava:anatomical study,pathogenesis and clinical considerations.Surg Radiol Anat,2006,28:206-210.
- [5]Gonzalez-Juanatey C,Testa A,Vidan J,et al.Persistent left superior vena cava draining into the coronary sinus:report of 10cases and literature review.Clin Cardiol,2004,27:515-518.