Surgical Treatment Experience of Emergency Surgery in Treating Rheumatic Valves Patients with Preoperative Ventricular Electrical Storm_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

葉生愛 , 張穎 , 于裕 , 鎮海文 , 張輝 , 趙揚 , 郁大江 , 陳振強 ,  程亮

南京中醫藥大學附屬醫院江蘇省中醫院心胸外科(南京 210029);

Corresponding?author：

程亮, Email: arron1978@sina.com

Keywords：

急診瓣膜手術; 風濕性心臟瓣膜病; 術前; 室性心動過速; 心室顫動

DOI：

10.7507/1007-4848.20160120

Video：

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目的探討成人風濕性心臟瓣膜病術前并發心室電風暴（惡性室性心動過速、心室顫動）行急診手術的療效及體會。方法回顧性分析2004年10月至2014年10月我院成人心臟瓣膜入院后突發惡性室性心動過速、心室顫動的患者6例，其中男2例，女4例，年齡35.0～64.0歲，平均49.8歲。6例患者均為風濕性心臟瓣膜病，二尖瓣中重度狹窄并主動脈瓣及三尖瓣中重度關閉不全2例，二尖瓣中重度關閉不全并三尖瓣中重度關閉不全4例，惡性心律失常發作后立即予艾司洛爾等藥物控制，病情基本穩定后急診手術。其中，行雙瓣膜置換+三尖瓣成形術2例，行二尖瓣置換+三尖瓣成形術4例。結果無圍術期患者死亡，術后無心功能顯著惡化、無多臟器功能衰竭、無惡性室性心律失常。術后1～2周24 h動態心電圖提示室性早搏大于1 000次的2例，室性早搏500～1 000次1例，小于500次的患者3例，短陣室性心動過速2次的患者2例，短陣室性心動過速3次的患者1例。所有6例患者均安全出院，隨訪6個月至10年，無患者死亡。結論急診外科手術聯合β受體阻滯劑在治療成人心臟瓣膜疾病術前突發的反復惡性室性心動過速、心室顫動安全有效。

Citation： 葉生愛, 張穎, 于裕, 鎮海文, 張輝, 趙揚, 郁大江, 陳振強, 程亮. Surgical Treatment Experience of Emergency Surgery in Treating Rheumatic Valves Patients with Preoperative Ventricular Electrical Storm. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(5): 512-514. doi: 10.7507/1007-4848.20160120 Copy

1.	Zipes D, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 Guide-lines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. JACC, 2006, 48:247-346.
2.	Srivatsa UN, Ebrahimi R, El-Bialy A, et al. Electrical storm:Case series and review of management. J Cardiovasc Pharmacol Ther, 2003, 8:237-246.
3.	Gao D, Sapp JL. Electrical storm:Definitions, clinical importance, and treatment. Curr Opin Cardiol, 2013, 28:72-79.
4.	郭潔, 丁超, 李俊峽, 等. 靜脈注射美托洛爾治療交感風暴相關惡性室性心律失常. 臨床誤診誤治, 2010, 23(3):249.
5.	魏捷, 杜賢進, 呂菁君, 等. 艾司洛爾治療室速或室顫的系統評價. 內科急危重癥雜志, 2012, 18(6):353-355.
6.	Chalvidan T, Deharo JC, Dieuzaide P, et al. Near fatal electrical storm in a patient equipped with an implantable cardioverter defibrillator for Brugada syndrome. Pacing Clin Electrophysiol, 2000, 23:410-412.
7.	Mitchell LB, Pineda EA, Titus JL, et al. Sudden death in patients with implantable cardioverter defibrillators:the importance of post-shock electromechanical dissociation. J Am Coll Cardiol, 2002, 39:1323-1328.
8.	Israel CW, Barold SS. Electrical storm in patients with an implanted defibrillator:a matter of definition. Ann Noninvasive Electrocardiol, 2007, 12:375-382.
9.	Eifling M, Razavi M, Massumi A. The evaluation and management of electrical storm. Tex Heart Inst J, 2011, 38(2):111-121.
10.	Tsagalou EP, Kanakakis J, Rokas S, et al. Suppression by propranolol and amiodarone of an electrical storm refractory to metoprolol and amiodarone. Int J Cardiol, 2005, 99(2):341-342.
11.	Billman GE, Castillo LC, Hensley J, et al. Beta2-adrenergic receptor antagonists protect against ventricular fibrillation:in vivo and in vitro evidence for enhanced sensitivity to beta2-adrenergic stimu-lation in animals susceptible to sudden death. Circulation, 1997, 96(6):1914-1922.
12.	Bourque D, Daoust R, Huard V, et al. Beta-blockers for the treat-ment of cardiac arrest from ventricular fibrillation? Resuscitation, 2007, 75:434-444.
13.	Sung RJ, Lo CP, Hsiao PY, et al. Targeting intracellular calcium cycling in catecholaminergic polymorphic ventricular tachycardia:a theoretical investigation. Am J Physiol Heart Circ Physiol, 2011, 301(4):H1625-1638.
14.	葉生愛, 張穎, 張輝, 等. 鹽酸艾司洛爾在成人心臟瓣膜病圍術期并發室性心動過速或心室顫動中的效果觀察. 中國綜合臨床, 2014, 30(10):1078-1080.
15.	陳振強, 張輝, 趙揚, 等. 風濕性心臟病聯合瓣膜病變引發電風暴一例. 中國胸心血管外科臨床雜志, 2007, 14(2):160.

1. Zipes D, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 Guide-lines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. JACC, 2006, 48:247-346.
2. Srivatsa UN, Ebrahimi R, El-Bialy A, et al. Electrical storm:Case series and review of management. J Cardiovasc Pharmacol Ther, 2003, 8:237-246.
3. Gao D, Sapp JL. Electrical storm:Definitions, clinical importance, and treatment. Curr Opin Cardiol, 2013, 28:72-79.
4. 郭潔, 丁超, 李俊峽, 等. 靜脈注射美托洛爾治療交感風暴相關惡性室性心律失常. 臨床誤診誤治, 2010, 23(3):249.
5. 魏捷, 杜賢進, 呂菁君, 等. 艾司洛爾治療室速或室顫的系統評價. 內科急危重癥雜志, 2012, 18(6):353-355.
6. Chalvidan T, Deharo JC, Dieuzaide P, et al. Near fatal electrical storm in a patient equipped with an implantable cardioverter defibrillator for Brugada syndrome. Pacing Clin Electrophysiol, 2000, 23:410-412.
7. Mitchell LB, Pineda EA, Titus JL, et al. Sudden death in patients with implantable cardioverter defibrillators:the importance of post-shock electromechanical dissociation. J Am Coll Cardiol, 2002, 39:1323-1328.
8. Israel CW, Barold SS. Electrical storm in patients with an implanted defibrillator:a matter of definition. Ann Noninvasive Electrocardiol, 2007, 12:375-382.
9. Eifling M, Razavi M, Massumi A. The evaluation and management of electrical storm. Tex Heart Inst J, 2011, 38(2):111-121.
10. Tsagalou EP, Kanakakis J, Rokas S, et al. Suppression by propranolol and amiodarone of an electrical storm refractory to metoprolol and amiodarone. Int J Cardiol, 2005, 99(2):341-342.
11. Billman GE, Castillo LC, Hensley J, et al. Beta2-adrenergic receptor antagonists protect against ventricular fibrillation:in vivo and in vitro evidence for enhanced sensitivity to beta2-adrenergic stimu-lation in animals susceptible to sudden death. Circulation, 1997, 96(6):1914-1922.
12. Bourque D, Daoust R, Huard V, et al. Beta-blockers for the treat-ment of cardiac arrest from ventricular fibrillation? Resuscitation, 2007, 75:434-444.
13. Sung RJ, Lo CP, Hsiao PY, et al. Targeting intracellular calcium cycling in catecholaminergic polymorphic ventricular tachycardia:a theoretical investigation. Am J Physiol Heart Circ Physiol, 2011, 301(4):H1625-1638.
14. 葉生愛, 張穎, 張輝, 等. 鹽酸艾司洛爾在成人心臟瓣膜病圍術期并發室性心動過速或心室顫動中的效果觀察. 中國綜合臨床, 2014, 30(10):1078-1080.
15. 陳振強, 張輝, 趙揚, 等. 風濕性心臟病聯合瓣膜病變引發電風暴一例. 中國胸心血管外科臨床雜志, 2007, 14(2):160.

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Surgical Treatment Experience of Emergency Surgery in Treating Rheumatic Valves Patients with Preoperative Ventricular Electrical Storm

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