切换至 "中华医学电子期刊资源库"

中华心脏与心律电子杂志 ›› 2023, Vol. 11 ›› Issue (03) : 182 -187. doi: 10.3877/cma.j.issn.2095-6568.2023.03.009

综述

心血管植入型电子器械相关的病理学改变及其临床意义
李延辉()   
  1. 215008 苏州,南京医科大学附属苏州医院心血管病中心
  • 收稿日期:2023-05-09 出版日期:2023-09-25
  • 通信作者: 李延辉

Clinical importance and cardiovascular pathological findings after cardiovascular implantable electronic devices implantation

Yanhui Li()   

  1. Cardiovascular Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215008, China
  • Received:2023-05-09 Published:2023-09-25
  • Corresponding author: Yanhui Li
引用本文:

李延辉. 心血管植入型电子器械相关的病理学改变及其临床意义[J]. 中华心脏与心律电子杂志, 2023, 11(03): 182-187.

Yanhui Li. Clinical importance and cardiovascular pathological findings after cardiovascular implantable electronic devices implantation[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(03): 182-187.

心血管植入型电子器械(CIED)经过半个多世纪的发展,对其相关的病理学改变的认识越来越深入。早年主要关注起搏器和植入型心律转复除颤器(ICD)的急性和慢性阈值改变及其病理学基础,而当前认识到其慢性病理学改变更加复杂而严重,这包括导致静脉入路的狭窄或阻塞、三尖瓣关闭不全、血栓形成或栓塞及CIED相关的感染、导线拔除。废弃、失功及感染导线拔除遇到的困难超出了想象,这反过来促使研究CIED相关的病理学改变,以揭示这些问题的病理学机制,以便在临床上更好地处理这些患者和相关的问题。

图1 上腔静脉的解剖毗邻关系(上腔静脉右心房连接处薄可透光5
图2 导线与锁骨下静脉、头臂静脉和上腔静脉的纤维结缔组织粘连(2A为导线在头臂静脉处形成的纤维结缔组织包裹;2B为将导线撕脱之后在上腔静脉近右心房处残留的纤维结缔组织(福尔马林固定标本[5])
图3 导线在心室部分的纤维结缔组织包裹以及与三尖瓣和腱索的粘连(3A为导线在三尖瓣隔瓣与后瓣之间穿过并与瓣膜和腱索发生粘连;3B为导线周围形成纤维结缔组织鞘并呈游离状态5
图4 经静脉拔除的起搏/除颤导线的大体观(激光导管拔除的导线,在导线尖端附有纤维结缔组织和心肌组织11
图5 激光导管拔除导线所致的上腔静脉撕裂(上腔静脉近心房处全层撕裂超过2 cm。经激光导管分离的导线上粘连的纤维结缔组织长度超过8 cm5
[1]
Yoko S, Kobayashi Y, Iiri T, et al. Pacing lead-induced granuloma in the atrium: a foreign body reaction to polyurethane[J]. Case Rep Cardiol, 2013:396595.
[2]
Esposito M, Kennergren C, Holmström N, et al. Morphologic and immunohistochemical observations of tissues surrounding retrieved transvenous pacemaker leads[J]. J Biomed Mater Res, 2002,63(5):548-558.
[3]
Novak M, Dvorak P, Kamaryt P, et al. Autopsy and clinical context in deceased patients with implanted pacemakers and defibrillators: intracardiac findings near their leads and electrodes[J]. Europace, 2009,11(11):1510-1516.
[4]
Segreti L, Di Cori A, Soldati E, et al. Major predictors of fibrous adherences in transvenous implantable cardioverter-defibrillator lead extraction[J]. Heart Rhythm, 2014,11(12):2196-2201.
[5]
李延辉, Dykoski Richard, 李剑明. 经静脉置入起搏/除颤导线引起的心脏血管慢性病理改变[J].中华心血管病杂志,2015,43(5):423-427.
[6]
Keiler J, Schulze M, Dreger R, et al. Quantitative and qualitative assessment of adhesive thrombo-fibrotic lead encapsulations (TFLE) of pacemaker and ICD leads in arrhythmia patients-a post mortem study[J]. Front Cardiovasc Med, 2020,7:602179.
[7]
Epstein AE, Kay GN, Plumb VJ, et al. Gross and microscopic pathological changes associated with nonthoracotomy implantable defibrillator leads[J]. Circulation, 1998,98(15):1517-1524.
[8]
Li JM, Li Y, Tholakanahalli V, et al. Fibrous encapsulation of defibrillation electrode and elevated high-voltage impedance in patients with a subcutaneous implantable cardioverter-defibrillator[J]. HeartRhythm Case Rep, 2019,6(3):148-152.
[9]
Frutos Perez JM, Llopis Sanchis M, Moreno Torres B, et al. Sudden death due to thrombosis associated with implantable cardioverter-defibrillator electrodes[J]. Eur J Case Rep Intern Med, 2021,8(3):002247.
[10]
Singer I, Hutchins GM, Mirowski M, et al. Pathologic findings related to the lead system and repeated defibrillations in patients with the automatic implantable cardioverter-defibrillator[J]. J Am Coll Cardiol, 1987,10(2):382-388.
[11]
李延辉, 李剑明. 激光导管拔除心脏起搏除颤导线的临床应用研究[J]. 中华心血管病杂志,2011,39(4):363-368.
[12]
Zhou X, Ze F, Li D, et al. Outcomes of transvenous lead extraction in patients with lead perforation: a single-center experience[J]. Clin Cardiol, 2020,43(4):386-393.
[13]
Van Rooden CJ, Molhoek SG, Rosendaal FR, et al. Incidence and risk factors of early venous thrombosis associated with permanent pacemaker leads[J]. J Cardiovasc Electrophysiol, 2004,15:1258-1262.
[14]
Zimetbaum P, Carroll BJ, Locke AH, et al. Lead-related venous obstruction in patients with implanted cardiac devices: JACC Review Topic of the Week[J]. J Am Coll Cardiol, 2022,79(3):299-308.
[15]
Dokainish H, Elbarasi E, Masiero S, et al. Prospective study of tricuspid valve regurgitation associated with permanent leads in patients undergoing cardiac rhythm device implantation: Background, rationale, and design[J]. Glob Cardiol Sci Pract, 2015,2015(3):41.
[16]
Addetia K, Harb SC, Hahn RT, et al. Cardiac Implantable electronic device lead-induced tricuspid regurgitation[J]. JACC Cardiovasc Imaging, 2019,12(4):622-636.
[17]
Rajappan K. Permanent pacemaker implantation technique: part II[J]. Heart, 2009,95(4):334-342.
[18]
Noheria A, Ponamgi SP, Desimone CV, et al. Pulmonary embolism in patients with transvenous cardiac implantable electronic device leads[J]. Europace, 2016,18(2):246-252.
[1] 郏亚平, 曾书娥. 含鳞状细胞癌成分的乳腺化生性癌的超声与病理特征分析[J]. 中华医学超声杂志(电子版), 2023, 20(08): 844-848.
[2] 贾春岩, 李月河. 涎腺腺泡细胞癌的超声表现及病理对照分析[J]. 中华医学超声杂志(电子版), 2023, 20(04): 462-466.
[3] 骆云凯, 鄢曹鑫, 张宣宣, 李如梅, 王文倩, 洪行行, 夏斌, 邹伟璞, 张珊珊, 陈剑. 声触诊弹性成像检测脾硬度对诊断慢性乙肝肝纤维化程度的应用价值[J]. 中华医学超声杂志(电子版), 2022, 19(11): 1232-1237.
[4] 戴佑任, 张悦, 李扬, 王聪, 陈婷, 程文俊, 罗成燕. 未分化/去分化子宫内膜癌的临床病理学特征及治疗研究[J]. 中华妇幼临床医学杂志(电子版), 2022, 18(06): 660-668.
[5] 陈珊, 胡智强, 张月明, 唐定, 黎蒙, 赵帅. Orai1、Orai3在乳腺癌组织中的表达及与病理学指标的相关性分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 514-517.
[6] 李晖, 范志勇, 耿西林, 常虎林, 吴武军, 张煜. 肝癌中线粒体膜蛋白ATAD3A表达与临床病理特征及预后的关系[J]. 中华普外科手术学杂志(电子版), 2023, 17(02): 157-161.
[7] 刘麒, 曾弘, 徐子昕, 方超, 黄铭, 郑俊炯, 吴少旭, 钟广正, 林天歆, 黄健, 董文. 乳头状肾细胞癌单中心11年临床诊治与预后分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 351-355.
[8] 孟锦雯, 刘治坤, 顾钰峰, 王建国, 杨帆, 郑树森, 徐骁. 基于卷积神经网络的肝细胞癌复发预警数字病理学模型研究[J]. 中华肝脏外科手术学电子杂志, 2023, 12(03): 272-277.
[9] 萨仁高娃, 张英霞, 邓伟, 闫诺, 樊宁. 超声引导下鼠肝消融术后组织病理特征的变化规律及影响[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 394-398.
[10] 徐军, 姬园园, 陈君平, 王健. 伴菊形团结构的脑膜瘤合并颅骨侵犯一例并文献复习[J]. 中华临床医师杂志(电子版), 2023, 17(08): 916-919.
[11] 陈颖, 曾万江. 病理组织学诊断在胎盘植入性疾病中的作用和意义[J]. 中华产科急救电子杂志, 2023, 12(03): 143-146.
[12] 努尔波勒, 马平, 诸玮. 甲状腺滤泡状癌的超声及临床病理特征分析[J]. 中华诊断学电子杂志, 2023, 11(04): 233-238.
[13] 柳发勇, 杨阳, 张功学, 邱珊, 齐峰, 常欢. 卵巢重度水肿的诊断学特征分析[J]. 中华诊断学电子杂志, 2023, 11(02): 128-132.
[14] 贾岩龙, 李锋, 武峰, 钟梓杰, 聂婷婷, 罗家滨, 罗锐. 钙化性腱膜纤维瘤的影像学特征[J]. 中华诊断学电子杂志, 2023, 11(01): 42-48.
[15] 陈丹丹, 潘文志, 陈莎莎, 张源, 张晓春, 李明飞, 周达新, 葛均波. 结构性心脏病年度报告2022[J]. 中华心脏与心律电子杂志, 2023, 11(03): 129-140.
阅读次数
全文


摘要