摘要
目的 回顾分析88例左室内补片心室成型治疗巨大室壁瘤的临床经验和手术效果。方法 手术前88例均有明确心肌梗死史。冠状动脉造影示梗阻性病变在左主干(LM)22例次、左前降支(LAD)88例次、对角支55例次、回旋支48例次、右冠状动脉30例次。除4例室壁瘤位于心脏下壁外,其余84例室壁瘤均位于心脏前壁和心尖。同时伴需手术矫正的瓣膜功能不全28例。88例均在全身麻醉、体外循环(cPB)下行左室内补片心室成型。87例同时冠状动脉搭桥(人均旁路1.87支);同时心脏瓣膜手术28例。结果88例均顺利度过手术。16例需主动脉内球囊反搏(IABP)支持11～90 h;二次开胸止血2例;手术后脑梗死2例;胸部切口感染并胸骨裂开1例,二次手术治愈;全组手术死亡2例,分别为严重低心排和多脏器功能衰竭综合征在手术后7 d和11d死亡;其余病人均康复出院。78例随访3～72个月,生活质量明显提高。手术后2周、3个月和6个月的左室射血分数分别为43％±10％,49％±14％和47％±12％,明显高于手术前(35％±17％)。结论左室内补片心室成型是治疗心肌梗死后巨大室壁瘤的有效方法。
Objective Retrospectively review the clinical experience of consecutive 88 patients who had left ventricular reconstruction with internal patch for huge left ventricular aneurysm. Methods This series included 88 patients with history of myocardial infarction (MI). All the aneu-rysms were located in the anterior wall except four whose aneurysms were in posterior wall. All had surgery under cardiopulmonary bypass. After the LV aneurysm was opened,all the mural thrombosis were removed and a Dacron patch of suitable size was put at the internal orifile between the aneurysm and normal myocardium by 2-0 Prolene suture to decrease the diameter of the orifile, to isolate the an-eurysm( include the infracted septal area), and to exclude all the rough internal surface with mural thrombosis. All but one had coronary artery bypass grafting at the same time. 28 patients had valve procedure simultaneously for heart valve dysfunction. Results All patients went through the surgery with average CPB time of 103 mins,and aortic cross clamp time of 68 mins. Sixteen patients needed in-tro-aortic balloon pump (IABP) support. Two cases were re-explored for bleeding. Two cases had stroke post-operatively with one full recovery. Sternal infection in one patient had sternal re-wired. There were two deaths in the group(one from Low cardiac output syndrom 7 days post-op,and another from multiple organ failure(MOF) 11 days post-op)with mortality of 2. 2%. 88. 6% cases had been followed up for an average of 24. 9 months. LVEF were improved significantly 2 weeks post-op(43± 10%) ,3 months post-op(49±14%) ,and 6 months post-op(47±12%). Conclusion For patients with huge left ventricular aneurysm, left ventricular reconstruction with internal patch is very effective.
出处
《江苏医药》
CAS
CSCD
北大核心
2004年第9期658-660,共3页
Jiangsu Medical Journal
