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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/OL]. 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/OL]. 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
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