Клинический случай имплантации бивентрикулярного электрокардиостимулятора у ребенка для лечения сердечной недостаточности

Heart failure is a complex of signs and symptoms appearing as a result of structural or functional disorders of heart that lead to inhibition of pump function. In newborns it's the heart failure causes death in 90 % of cases. Children with the isolated right ventricular apex cardiac pacing systems are exposed to risk of left ventricular failure due to myocardial dissynchrony caused by chronic pacing of right ventricle. In these patients cardiac resynchronization therapy is used as it favors the improvement of myocardial contractile function, increasing of ejection fraction and synchronous contraction of the left ventricular myocardium. These effects in turn contribute to clinical improvement. In children over 10 kg an endocardial approach is preferable. This method in some cases allows to avoid thoracotomy and general anesthesia. However, in unsuccessful cases or lead dislocation from the coronary sinus (accounts for up to 9 %) combined or isolated surgical approaches are used. The former approach is characterized by the left ventricular lead positioned epicardially and other leads are implanted endocardially. The latter approach allows to implant all three pacing leads (atrial, right ventricular and left ventricular leads) epicardially during standard operation.