急性心肌梗死后左心室游离壁破裂的手术策略

Surgical strategy for left ventricular free wall rupture after acute myocardial infarction.

作者信息

Iemura J, Oku H, Otaki M, Kitayama H, Inoue T, Kaneda T

机构信息

Department of Cardiac Surgery, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.

出版信息

Ann Thorac Surg. 2001 Jan;71(1):201-4. doi: 10.1016/s0003-4975(00)02211-6.

DOI:10.1016/s0003-4975(00)02211-6

PMID:11216746

Abstract

BACKGROUND

Left ventricular free wall rupture is usually fatal without surgical intervention. However, the most appropriate surgical procedure remains controversial.

METHODS

Seventeen patients (14 men, 3 women) who developed left ventricular free wall rupture after acute myocardial infarction were treated surgically. Their mean age was 65.4 years (range, 55 to 79 years). The following surgical procedures were performed: infarctectomy and patch reconstruction in 1 patient, direct closure with or without patch covering in 4 patients, simple patch covering anchored by running suture in 4 patients, and a sutureless technique in 7 patients. Endventricular patch closure was performed in 1 patient with ventricular septal perforation.

RESULTS

One of 3 patients with a blow-out type rupture and 1 of 13 patients with an oozing type rupture died shortly after operation. The overall surgical mortality rate was 11.8%.

CONCLUSIONS

Selection of the optimal procedure for each cardiac condition is important for obtaining good results. For patients with ongoing squirting bleeding, patch covering is the technique of choice. For oozing, the sutureless technique is preferable.

摘要

背景

左心室游离壁破裂若不进行手术干预通常会致命。然而，最合适的手术方式仍存在争议。

方法

17例急性心肌梗死后发生左心室游离壁破裂的患者接受了手术治疗。他们的平均年龄为65.4岁（范围55至79岁）。实施了以下手术方式：1例患者行梗死灶切除术及补片重建术，4例患者行直接缝合（有或无补片覆盖），4例患者行连续缝合固定的单纯补片覆盖术，7例患者采用无缝合技术。1例合并室间隔穿孔的患者行心室内补片闭合术。