RESYNCHRONISATION FOR CHRONICALLY FAILING SUB-PULMONARY RIGHT VENTRICLE IN PATIENTS WITH CONGENITAL HEART DISEASE
Tématický okruh: Pediatrická kardilogie | |||||||||||||||||||||||||||||
| Typ: Ústní sdělení - lékařské , Číslo v programu: 683 | |||||||||||||||||||||||||||||
| Kubuš P.1, Tomek V.1, Ložek M.2, Janoušek J.1 1 Dětské kardiocentrum 2. LF UK a FN v Motole, FN v Motole, Praha, 2 Katedra teorie obvodů, Fakulta elektrotechnická, České vysoké učení technické v Praze, Praha | |||||||||||||||||||||||||||||
Aim: Resynchronisation of the sub-pulmonary right ventricle (RV CRT) is a potential therapeutic option for dyssynchronous RV cardiomyopathy. Methods: Nine pts (<18 yrs, median = 6.8 yrs) with complete right bundle branch block and RV dysfunction by MRI and/or echocardiography after surgical repair of congenital heart disease were intended to be treated by RV CT (atrial-synchronised RV free wall pacing in complete fusion with spontaneous activation). Results: Temporary pacing was used to assess acute RV CRT effect as compared to spontaneous ventricular activation and carried significant decrease in QRS duration, septal to lateral RV mechanical delay by 2D strain (SL delay) with abolition of the pathological septal flash and increase in RV and left ventricular filling time (RVFT and LVFT, expressed as % cycle length) and pulmonary artery velocity time integral (VTI), see Table. Permanent RV CRT was applied in 2/9 pts (tetralogy of Fallot, absent pulmonary valve syndrome) with symptoms of RV failure and major effect of temporary resynchronisation. Ventricular pacing leads were inserted at the site of late RV free wall activation (q-RV = 70 and 100% of QRS duration, resp.). Major lasting improvement in RV function, mechanical synchrony and functional class was achieved in both pts over a follow-up of 14 and 37 months, resp. Conclusion: Electromechanical dyssynchrony may play a significant role in sub-pulmonary RV failure development and can be effectively corrected by RV CRT to achieve both acute and long-term improvement of RV function. (Supported by MH CZ-DRO, University Hospital Motol, Prague, Czech Republic 00064203)
| |||||||||||||||||||||||||||||