小兒風濕性心臟病所致心房顫動之自然史

The Natural History of Atrial Fibrillation in Childhood Rheumatic Heart Disease

鄭素珠(Su-Ju Cheng) ； 呂鴻基(Hung-Chi Lue) ； 陳烱霖(Chiung-Lin Chen)

《Acta Paediatrica Sinica》 18卷1期 (1977/03) Pp. 24-31

摘要

自民國50年至64年的15年間，臺大醫院小兒科共有343例風濕熱及風濕性心臓病兒住院，其中發生心房顫動者有36例，發生率爲10.5%，男女各半；由發生心炎至心房顫動出現的經過爲4個月至13年（平均4.4年）；半數以上(61.1%)由風濕熱復發而發生，約85%伴有心臓衰竭。
心房顫動病例中以僧帽瓣狹窄併閉鎖不全爲最常見。追踪檢查期間由4個月至15年（平均4.6年），17例(47%)死亡，15例(88.2%)於心房顫動發生後三年內死亡，其中9例(52.9%)於心房顫動發生後一年內死亡，死因多為心臓衰竭。
一過性或陣發性心房顫動患者一般預後較佳，以內科藥物治療卽恢復竇性律者有8例(22%)，需手術治療者有15例，不論心瓣膜置換、瓣環整形或瓣膜連合切開，手術後心房顫動仍持續。心房顫動的發生有很大的預後意義，一旦發生持續性心房顫動，死亡率增高。

並列摘要

During the 15 year period of 1961 to 1975, a total of 343 cases of rheumatic fever (RF) and rheumatic heart disease (RHD) were admitted to the pediatric department of the National Taiwan University Hospital. In 39 cases (11%) developed tachyarrhythmias: A-V dissociation in two, Wolf-Parkison-White syndrome with supraventricular tachycardia in one, and atrial fibrillation (AF) in thirty-six cases. In the present communication, the results of our long term follow-up study of these 36 children with AF are reported.
The sex ratio was 18:18. The time interval since the first diagnosis of carditis to the onset of atrial fibrillation ranged from 4 months to 13 years with a mean of 4.4 years. In more than a half of the cases (61.1%), the development of fibrillation was associated with or triggered by the RF recurrence; and in 86.1% of AF cases congestive heart failure was encountered. Embolization was not observed in any of our cases.
Of those who developed AF, twenty-eight cases had mitral stenoinsufficiency, four mitral insufficiency, two mitral stenoinsufficiency and aortic insufficiency, one mitral stenosis and the remaining one mitral and tricuspid insufficiency. Mitral stenoinsufficiency was the most frequently seen valvular lesion leading to atrial fibrillation.
Thirty-two cases had the roentogenological evidence of severe cardiomegaly. Cardiac catheterization was done in 17 cases. The pulmonary artery wedge pressure was measured in 11 cases. They ranged from 9 to 44 mmHg, with an average of 23 mmHg. In two cases the wedge pressure was normal. All of the cases were followed up for 4 months to 15 years with an average of 4.6 years. Seventeen cases (47%), including 4 cases undergone surgical intervention, died. Death took place within one year after the onset of AF in nine cases, within two years in one, within three years in five, and within four and seven years in one each. The cause of death was mostly due to congestive heart failure. Spontaneous conversion to normal sinus rhythm occurred in eight cases (22%) after medical treatment. Those whose AF proved to be a transient paroxysm ran a relatively benign course. Surgical intervention was required in 15 cases: eleven underwent mitral valve replacement; three annuloplasty and one commissurotomy. The AF persisted in all cases who survived the surgery.

並列關鍵字

rheumatic heart disease ； atrial fibrillation ； natural history