Ohara K
Department of Thoracic and Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan.
Ann Thorac Cardiovasc Surg. 2000 Oct;6(5):289-94.
The surgical strategy for left ventricular (LV) aneurysm after myocardial infarction has been changing recently. Conventionally, linear aneurysmectomy has been widely performed as a standard procedure for post-infarction LV aneurysm. However, this technique remains unsatisfactory because LV distortion occurs postoperatively and an akinetic or dyskinetic area persists in the ventricular septum, resulting in limited improvement of cardiac function. To overcome these problems, Dor and associates excluded all akinetic or dyskinetic myocardium from the left ventricle including the septum and placed a tight circumferential suture around the aneurysmal base to reduce the LV volume and return the LV contour to near normal (endoventricular circular patch plasty: EVCPP). As an alternative to conventional linear aneurysmectomy, EVCPP (Dor's operation) is now being performed more widely for the treatment of post-infarction LV aneurysm, and it achieves better postoperative cardiac function. Recently, EVCPP has attracted interest as a treatment for post-infarction large akinetic scars and ischemic cardiomyopathy (ICM), both of which have a poor prognosis. In this article, based on the author's clinical experience and on the literature, EVCPP is reviewed with respect to its indications for patients with post-infarction LV aneurysm or large akinetic scars, and pointers and results for this technique are discussed.
近期，心肌梗死后左心室（LV）室壁瘤的手术策略一直在发生变化。传统上，线性室壁瘤切除术作为心肌梗死后LV室壁瘤的标准术式已被广泛应用。然而，该技术仍不尽人意，因为术后会出现左心室变形，室间隔仍存在运动减弱或运动障碍区域，导致心功能改善有限。为克服这些问题，多尔及其同事将包括室间隔在内的左心室内所有运动减弱或运动障碍的心肌组织切除，并在瘤体基底部进行紧密的环形缝合，以减小左心室容积，使左心室轮廓恢复至接近正常（心室内环形补片成形术：EVCPP）。作为传统线性室壁瘤切除术的替代方法，EVCPP（多尔手术）目前在治疗心肌梗死后LV室壁瘤方面应用更为广泛，且术后心功能更佳。近来，EVCPP作为治疗心肌梗死后大面积运动减弱瘢痕和缺血性心肌病（ICM）的方法引起了关注，这两种疾病预后均较差。本文基于作者的临床经验及文献，对EVCPP在心肌梗死后LV室壁瘤或大面积运动减弱瘢痕患者中的适应证、该技术的要点及结果进行综述。
