Kondo K, Sawada Y
Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki 569-8686, Japan.
Ann Thorac Cardiovasc Surg. 2000 Apr;6(2):95-9.
A concept of volume reduction surgery for patients with end-stage dilated cardiomyopathy was introduced to the surgical aspect. We started consequently to employ this operation for patients with ischemic cadiomyopathy. Between October 1997 and April 1999, 14 patients (mean age 64 years; 12 men, 2 women) underwent endoventricular circular patch plasty (EVCPP) in our institute.
The left ventricle (LV) is opened by placing an incision parallel to the left anterior descending (LAD) coronary artery. An endocardial purse-string suture is placed circumferentially at the root of the posterior papillary muscle. The remaining opening of the cavity is closed with a circular bovine pericardial patch. The excluded edges of LV free wall and septum are directly closed with felt strips.
There were no significant hemodynamic differences in heart rate, cardiac index and pulmonary capillary wedge pressure before and after the operation. Either LV end-diastolic volume index (from 134.8 +/- 30.7 to 77.1 +/- 16.3 ml/m2) or LV end-systolic volume index (from 85.0 +/- 21.8 to 40.0 +/- 12.5 ml/m2) definitely reduced postoperatively, the LV ejection fraction (EF), consequently, significantly improved from 0.31 +/- 0. 09 to 0.48 +/- 0.10 (p=0.0007). In all patients the New York Heart Association (NYHA) functional class improved from 2.8 +/- 0.7 to 1.3 +/- 0.5 after operation. We will aggressively employ this procedure for patients with ischemic cardiomyopathy in consideration of the limitations of the efficacy and the indication of this operation.
终末期扩张型心肌病患者的减容手术概念被引入外科领域。因此，我们开始将此手术应用于缺血性心肌病患者。1997年10月至1999年4月，14例患者（平均年龄64岁；12例男性，2例女性）在我院接受了心室内环形补片成形术（EVCPP）。
沿左前降支（LAD）冠状动脉平行方向做切口打开左心室（LV）。在后乳头肌根部环形放置心内膜荷包缝合线。用圆形牛心包补片封闭腔室的其余开口。左心室游离壁和室间隔的切除边缘用毡条直接缝合。
手术前后心率、心脏指数和肺毛细血管楔压无显著血流动力学差异。术后左心室舒张末期容积指数（从134.8±30.7降至77.1±16.3 ml/m²）和左心室收缩末期容积指数（从85.0±21.8降至40.0±12.5 ml/m²）均明显降低，左心室射血分数（EF）因此从0.31±0.09显著提高至0.48±0.10（p = 0.0007）。所有患者术后纽约心脏协会（NYHA）心功能分级从2.8±0.7改善至1.3±0.5。考虑到该手术疗效和适应证的局限性，我们将积极地将此手术应用于缺血性心肌病患者。
