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：

叶生爱 , 张颖 , 于裕 , 镇海文 , 张辉 , 赵扬 , 郁大江 , 陈振强 ,  程亮

南京中医药大学附属医院江苏省中医院心胸外科(南京 210029);

Corresponding author：

程亮, Email: arron1978@sina.com

Keywords：

急诊瓣膜手术; 风湿性心脏瓣膜病; 术前; 室性心动过速; 心室颤动

DOI：

10.7507/1007-4848.20160120

Video：

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目的探讨成人风湿性心脏瓣膜病术前并发心室电风暴（恶性室性心动过速、心室颤动）行急诊手术的疗效及体会。方法回顾性分析2004年10月至2014年10月我院成人心脏瓣膜入院后突发恶性室性心动过速、心室颤动的患者6例，其中男2例，女4例，年龄35.0～64.0岁，平均49.8岁。6例患者均为风湿性心脏瓣膜病，二尖瓣中重度狭窄并主动脉瓣及三尖瓣中重度关闭不全2例，二尖瓣中重度关闭不全并三尖瓣中重度关闭不全4例，恶性心律失常发作后立即予艾司洛尔等药物控制，病情基本稳定后急诊手术。其中，行双瓣膜置换+三尖瓣成形术2例，行二尖瓣置换+三尖瓣成形术4例。结果无围术期患者死亡，术后无心功能显著恶化、无多脏器功能衰竭、无恶性室性心律失常。术后1～2周24 h动态心电图提示室性早搏大于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，短阵室性心动过速2次的患者2例，短阵室性心动过速3次的患者1例。所有6例患者均安全出院，随访6个月至10年，无患者死亡。结论急诊外科手术联合β受体阻滞剂在治疗成人心脏瓣膜疾病术前突发的反复恶性室性心动过速、心室颤动安全有效。

Citation： 叶生爱, 张颖, 于裕, 镇海文, 张辉, 赵扬, 郁大江, 陈振强, 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.	郭洁, 丁超, 李俊峡, 等. 静脉注射美托洛尔治疗交感风暴相关恶性室性心律失常. 临床误诊误治, 2010, 23(3):249.
5.	魏捷, 杜贤进, 吕菁君, 等. 艾司洛尔治疗室速或室颤的系统评价. 内科急危重症杂志, 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.	叶生爱, 张颖, 张辉, 等. 盐酸艾司洛尔在成人心脏瓣膜病围术期并发室性心动过速或心室颤动中的效果观察. 中国综合临床, 2014, 30(10):1078-1080.
15.	陈振强, 张辉, 赵扬, 等. 风湿性心脏病联合瓣膜病变引发电风暴一例. 中国胸心血管外科临床杂志, 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. 郭洁, 丁超, 李俊峡, 等. 静脉注射美托洛尔治疗交感风暴相关恶性室性心律失常. 临床误诊误治, 2010, 23(3):249.
5. 魏捷, 杜贤进, 吕菁君, 等. 艾司洛尔治疗室速或室颤的系统评价. 内科急危重症杂志, 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. 叶生爱, 张颖, 张辉, 等. 盐酸艾司洛尔在成人心脏瓣膜病围术期并发室性心动过速或心室颤动中的效果观察. 中国综合临床, 2014, 30(10):1078-1080.
15. 陈振强, 张辉, 赵扬, 等. 风湿性心脏病联合瓣膜病变引发电风暴一例. 中国胸心血管外科临床杂志, 2007, 14(2):160.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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

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