Prêtre R, Linka A, Jenni R, Turina M I
Department of Cardiovascular Surgery, University Hospital Zürich, Switzerland.
Ann Thorac Surg. 2000 Aug;70(2):553-7. doi: 10.1016/s0003-4975(00)01412-0.
We present a review of our experience with acquired pseudoaneurysms of the left ventricle in order to establish the risk of surgical repair.
Ten patients operated upon for a left ventricular pseudoaneurysm in our clinic between 1984 and 1999 were reviewed. The pseudoaneurysm, a complication of myocardial infarction (four acute and three chronic) or previous cardiac surgery (three chronic), was resected in all patients and the ventricular wall defect closed with direct sutures (five cases) or a patch (five cases). Coronary artery bypass graft was performed in 6 patients.
Three patients died (postoperative mortality 30%) after repair of an acute postinfarction (2 patients) or a chronic postsurgical (1 patient) pseudoaneurysm. Three patients died during follow-up (median 4 years) of a carcinological (2 patients) or cardiac (1 patient) cause. Two years after repair, 5 patients were in New York Heart Association class I or II, and 1 patient was in class III.
Repair of left ventricular pseudoaneurysms can be performed with acceptable results, although mortality is significant in acute myocardial infarction and redo operations. Propensity for fatal rupture, however, is higher than the surgical risk in acute pseudoaneurysms or in large or expanding chronic ones and warrants surgical repair. The best approach to small asymptomatic chronic pseudoaneurysm is unsettled.
我们回顾了我们在左心室后天性假性动脉瘤方面的经验，以确定手术修复的风险。
回顾了1984年至1999年间在我们诊所接受左心室假性动脉瘤手术的10例患者。假性动脉瘤是心肌梗死（4例急性和3例慢性）或既往心脏手术（3例慢性）的并发症，所有患者均行假性动脉瘤切除术，心室壁缺损采用直接缝合（5例）或补片（5例）关闭。6例患者进行了冠状动脉旁路移植术。
3例患者在修复急性心肌梗死后（2例）或慢性手术后（1例）假性动脉瘤后死亡（术后死亡率30%）。3例患者在随访（中位时间4年）期间死于癌症（2例）或心脏（1例）原因。修复后两年，5例患者纽约心脏协会心功能分级为I级或II级，1例为III级。
左心室假性动脉瘤的修复可以取得可接受的结果，尽管在急性心肌梗死和再次手术中死亡率较高。然而，急性假性动脉瘤或大型或不断扩大的慢性假性动脉瘤的致命破裂倾向高于手术风险，因此需要进行手术修复。对于小型无症状慢性假性动脉瘤的最佳治疗方法尚无定论。
