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Pacing Options in the Adult Patient with Congenital Heart Disease - part 8

Cine fluoroscopic ngực, xem postero trước (PA), cho thấy nhịp lưỡng cực tâm nhĩ ở một bệnh nhân với các thủ tục mù tạt từ một kỷ nguyên trước khi dẫn lưỡng cực đã có sẵn. Một dẫn (cathode) trong tâm nhĩ trái và khác (anode) được gắn vào vách ngăn | 96 Chapter 20 Figure 20.9 Mustard procedure for transposition of the great vessels. Chest cine fluoroscopic postero-anterior PA views of a superior vena caval venogram. Left Baffle obstruction at the junction of the baffle with the right atrium and superior vena cava. Right Stent placement with wide opening of the baffle. Patient growth and vena caval-baffle angulation typically is responsible for such obstructions. Figure 20.10 Mustard procedure for transposition of the great vessels. Chest cine fluoroscopic postero-anterior PA view showing bipolar atrial pacing in a patient with the Mustard procedure from an era before bipolar leads were available. One lead cathode is in the left atrium and the other anode is attached to baffle material as it it was not possible to attach it to the stump of the right atrium. The anode lead would not pace the atrium but the lead combination allowed satisfactory long-term bipolar atrial pacing. Once identified vascular stents can be effectively used to open the obstructed baffle regions followed by pacing lead implant Figure 20.9 . However due to continued lead-stent neo-intimal interactions following implant vessel restenosis may reoccur necessitating continued close follow-up care 64 . In a patient with sick sinus syndrome and baffle stenosis it may still be possible to position an atrial lead into a stub of right atrial appendage close to where it attaches to the baffle Figure 20.10 223 . On intraoperative testing atrial pacing may not be possible or a very high D-Transposition of the great vessels 97 Figure 20.11 Mustard procedure for transposition of the great vessels. Above Chest radiographs postero-anterior PA and left lateral L Lat showing dual chamber pacing in a patient with the Mustard procedure. In the PA view active-fixation leads are attached to the roof of the left atrium and lateral wall of the left ventricle. In the L Lat view both leads lie posterior. Below Resting 12-lead ECG from the same patient demonstrating .