Delayed AV Block after Ventricular Myomectomy in Hypertrophic Cardiomyopathy

肥厚性阻塞性心肌病變於接受左心室中膈心肌切除術後發生延遲性房室傳導阻滯

留以堅(Yi-Chien Liu) ； 江碩儒(Shuo-Ju Chiang) ； 陳適安(Shih-Ann Chen) ； 柯景塘(Jung-Tang Ko)

《北市醫學雜誌》 1卷4期 (2004/10) Pp. 487-492

https://doi.org/10.6200/TCMJ.2004.1.4.14

摘要

肥厚性阻塞性心肌病變之特性即是由於左心室中膈肥厚導致左心室出口阻塞，臨床上對於此類病患之治療方式包括藥物、節律器或者經由導管選擇性於心室中膈血管注入酒精產生部分心肌壞死而減少心肌質量的非手術性治療；手術性治療則是以切除部分肥厚之心室中膈來解除左心室出口阻塞。
心室中膈心肌切除術後常見之併發症主要是心律傳導障礙，其中以立即發生之左束枝傳導阻滯最常見，而發生完全性房室傳導阻滯之機率約在百分之一至百分之一之問。本病例報告一位二十歲肥厚性阻塞性心肌病變之男性病人，接受心室中膈心肌切除術後產生左右束枝傳導阻滯，而於十二個月後發生陣發性完全房室傳導阻滯之情況。在心臟電生理檢查後發現病人存在希氏束下之傳導障礙，最後病人接受植入永久性之心臟節律器。

關鍵字

房室傳導阻滯 ； 心肌切除術 ； 肥厚性阻塞性心肌病變

並列摘要

Hypertrophic obstructive cardiomyopathy is characterized by left ventricular obstruction. The treatment of this condition has included the use of pharmacologic agents, atrioventricular sequential pacing, non-surgical alcoholic ablation of the hypertrophic septum and surgery. Techniques for operative management of hypertrophic cardiomyopathy are highly varied. Conduction problems after surgery most often include new left bundle branch block (3%-65%). From the literature, the incidence of immediate complete heart block after surgery is low (1%-i 0%). We report a patient with hypertrophic obstructive cardiomyopathy who received a modified Konno-Rastan procedure due to refractory symptoms under medical treatment. Bifascicular block occurred post-operatively. Unfortunately, paroxysmal complete heart block occurred 12 months later. Electrophysiologic study showed infra-Hisian block at a right atrium pacing cycle length of 470 msec under infusion of procanamide. Finally, a permanent VDD pacemker was implanted to maintain the resting rate.

並列關鍵字

AV block ； myomectomy ； hypertrophic cardiomyopathy