放置心房中隔缺損閉合器時用電流整律改變心律及分流方向之病例報告

Cardioversion Corrects Cardiac Arrhythmia and Reverts the Resultant Reversed Shunt Flow Direction during Transcatheter Closure of Atrial Septal Defect-- A Case Report

心房中隔缺損的分流方向是決定缺損是否可以經由手術或心導管方式關閉的重要因素，而許多的生理變化包括全身麻醉或心律不整都會影響分流方向。一位預計要放置心房中隔缺損閉合器的五十三歲病人在術中發現分流方向從由左至右變為雙向，在其他保守方法都失敗後使用電流整律將心房撲動轉變為正常竇性節律後成功地將分流方向變回由左至右。

Closure of atrial septal defect (ASD) is critically dependent on the shunt flow direction. However, shunt flow direction through ASD may change under variable clinical conditions. We present here a 53 year-old woman with a confirmed left-to-right shunt ASD prior to Amplatzer Septal Occluder placement. The development of atrial flutter during the procedure had been found to change the shunt from unidirectional to bidirectional and the procedure was then forced to a temporary halt. The cardiac arrhythmia and altered shunt direction simultaneously reverted to the old state after cardioversion. A successful placement of Amplatzer septal occluder was successfully performed afterward and she recovered uneventfully.