Obayashi T, Kaneko T, Nogami A, Naito S, Iijima T, Murai N, Aizaki M
Division of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
Kyobu Geka. 1999 Mar;52(3):229-33.
A 74-year-old woman admitted with exertional dyspnea. Echocardiography revealed the giant left ventricular aneurysm. In the hospital course, she fell into sustained monomorphic ventricular tachycardia. Coronary angiogram showed complete obstruction of the LAD. Left ventricular ejection fraction was 20%. The origin of tachycardia seems to be at infero-apicallateral area of LV by electrophysiology study. Because of the failure of RF energy ablation, we planned mapping-guided cryoablation, CABG and endoaneurysmorrhaphy. To prevent air embolism and myocardial ischemic damage for long aortic cross clamp, intraoperative endocardial mapping was carried out on beating heart due to continuous normothermic coronary blood perfusion (300 ml/min) from the aortic root cannula under aortic clamping. Cold crystalloid cardioplegia changed into the root cannula after EPS, focal cryoablation (-100 degrees C) was performed 3 times on cardiac arrest. Sustained VT was not inducible in the following study. CABG and endoaneurysmorrhaphy was performed on repeated cardiac arrest during single aortic clamp. Postoperative course was uneventful, and she discharged 8 weeks after the operation.
一名74岁女性因劳力性呼吸困难入院。超声心动图显示巨大左心室室壁瘤。在住院期间，她出现持续性单形性室性心动过速。冠状动脉造影显示左前降支完全闭塞。左心室射血分数为20%。通过电生理研究，心动过速的起源似乎位于左心室下尖外侧区域。由于射频能量消融失败，我们计划进行标测引导下的冷冻消融、冠状动脉旁路移植术（CABG）和心室内膜瘤修补术。为防止长时间主动脉阻断导致空气栓塞和心肌缺血损伤，在主动脉阻断下，通过主动脉根部插管持续进行常温冠状动脉血液灌注（300毫升/分钟），在跳动的心脏上进行术中的心内膜标测。电生理检查（EPS）后，将冷晶体心脏停搏液换成根部插管，在心脏停搏时进行3次局部冷冻消融（-100摄氏度）。在随后的检查中未诱发出持续性室性心动过速。在单次主动脉阻断期间，在反复心脏停搏时进行了冠状动脉旁路移植术和心室内膜瘤修补术。术后病程平稳，她在术后8周出院。
