摘要
目的 总结分析 2 5例心肌梗死并发症的外科治疗方法与效果。方法 伴有心肌梗死并发症的冠心病 2 5例 ,左室室壁瘤 17例 ,室间隔穿孔者 7例 ,乳头肌功能不全所致二尖瓣关闭不全 10例。 2 5例均手术治疗 :手术处理室壁瘤 13例 ,其中室壁瘤切除术 6例 ,附加室间隔穿孔修补术 6例 ,同时行二尖瓣成形术 1例。另有室间隔穿孔修补术 1例和二尖瓣成形 1例 ;同时行冠状动脉搭桥术者 19例 ,其中单纯冠状动脉搭桥术而未处理心梗并发症者 10例。结果 手术死亡 4例 ,包括 1例室壁动脉瘤切除及 3例室间隔穿孔修补 ,其中新发生围手术期心梗 1例 ,远期死亡 3例 ,远期心功能不全 2例 ,无心绞痛复发。结论 对于无症状室壁瘤和轻 -中度二尖瓣反流应采取相对保守的外科治疗方法 ,完全的再血管化手术可能对远期改善有利。
Objective To report 25 cases with complications following myocardial infarction and discuss the surgical treatment and its results.Methods In the 25 cases,there were 17 cases left ventricular aneurysm (VA),7 cases ventricular septal perforation (VSP) and 10 cases mitral insufficiency (MI).The 25 cases all received operation.There were 6 VA resection,6 VA resection plus repair of VSP,1 VA resection plus mitral valvuloplasty,1 repair of VSP and 1 mitral valvuloplasty.In addition,19 coronary artery bypass were performed,10 of whom were only revascularization without dealing with complications.Results Four operative death included one VA resection and three repair of VSP.There was one case perioperative infarction.Three late death including two late heart failure and no recurrent angina.Conclusions It may be recommended that relatively conservative strategy could be adopted in asymptomatic VA and mild to middle MI.The total revascularization may benefit late improvement.VSP may still be a challenge to surgical treatment,whose effectiveness may have close relationship with the timing of surgical intervention.
出处
《北京医学》
CAS
北大核心
2001年第5期266-268,共3页
Beijing Medical Journal
