Flajsig Igor, Castells y Cuch Eduardo, Mayosky Alejandro Ariel, Rodriguez Rafael, Calbet Jose Maria, Saura Emilio, Fontanillas Carles, Granados Jorge, Miralles Albert, Benito Miguel, Rabasa Jose Manuel, Sbraga Fabrizio, Rullan Catalina, Octavio de Toledo Maria Carmen
Department of Heart Surgery, Ciudad Sanataria i Universitaria de Bellvitge, L'Hospitalet, Barcelona, Spain.
Croat Med J. 2002 Dec;43(6):643-8.
To analyze the results of surgical treatment of left ventricular free wall rupture after acute myocardial infarct in a case series.
From 1984 to 2001, 25 patients (10 women and 15 men) were surgically treated in our Center for left ventricular free wall rupture after acute myocardial infarction. Their mean age was 62 years (range, 42-80). Cardiac symptoms (chest pain and/or dyspnea) prior to admission were recorded in 4 patients. One patient had acute myocardial infarction of the anterolateral wall, 6 patients of the lateral wall, 13 patients of the anterior wall, 4 patients of the inferior wall, and one patient had a right ventricle infarction. Thrombolytic therapy was administered in 10 patients, according to the criteria of the American Heart Association and Spanish Society of Cardiology criteria. In all patients, the final diagnosis was established echocardiographically before the surgery.
All patients underwent surgical intervention on an emergency basis. Extracorporeal circulation was used in the first 9 cases, whereas the next 16 patients had off-pump surgery. Two patients had heart arrest during off-pump surgery, which required extracorporeal circulation support. One patient was found false positive for rupture only at surgery. In the first 4 cases, we performed a direct suture after excising necrotic tissue, in the next 15 cases we sutured a patch over the infarction zone, and in the last 5 patients we used Teflon patch fixed with fibrin glue and polypropylene and stitched to the epicardium with a continuous suture. Out of 24 patients, 8 died: one in the surgical room from uncontrollable bleeding and another 7 between 30 and 90 days after the surgery in the intensive care unit. All of them underwent surgery with extracorporeal circulation. There were no deaths among the patients undergoing off-pump surgery. Three out of 4 patients in whom direct suture and necrotic tissue excision was performed died in the hospital. Five out of 19 patients in whom patch correction with direct suture was done died in the hospital.
The left ventricle free wall rupture, as a complication of acute myocardial infarction, can be diagnosed early and treated on time. Rapid diagnosis and emergency surgery are crucial for successful treatment of patients with impending heart rupture. Off-pump surgery and patch with glue technique seem to yield best results.
分析一组急性心肌梗死后左心室游离壁破裂的外科治疗结果。
1984年至2001年，我院中心对25例急性心肌梗死后左心室游离壁破裂患者（10例女性，15例男性）进行了外科治疗。他们的平均年龄为62岁（范围42 - 80岁）。4例患者记录了入院前的心脏症状（胸痛和/或呼吸困难）。1例患者为前侧壁急性心肌梗死，6例为侧壁，13例为前壁，4例为下壁，1例为右心室梗死。根据美国心脏协会和西班牙心脏病学会的标准，10例患者接受了溶栓治疗。所有患者在手术前均通过超声心动图确诊。
所有患者均接受了急诊手术。前9例患者使用了体外循环，而后16例患者进行了非体外循环手术。2例患者在非体外循环手术期间发生心脏骤停，需要体外循环支持。1例患者仅在手术时被发现破裂为假阳性。前4例患者，我们在切除坏死组织后进行了直接缝合；接下来的15例患者，我们在梗死区域缝合了补片；最后5例患者，我们使用了用纤维蛋白胶和聚丙烯固定并用连续缝合缝至心外膜的特氟龙补片。24例患者中，8例死亡：1例在手术室因无法控制的出血死亡，另外7例在手术后30至90天内死于重症监护病房。他们均接受了体外循环手术。非体外循环手术患者无死亡病例。4例进行直接缝合和坏死组织切除的患者中有3例在医院死亡。19例进行直接缝合补片矫正的患者中有5例在医院死亡。
左心室游离壁破裂作为急性心肌梗死的一种并发症，可以早期诊断并及时治疗。快速诊断和急诊手术对于即将发生心脏破裂的患者的成功治疗至关重要。非体外循环手术和胶水补片技术似乎能产生最佳效果。
