Trehan Naresh, Kohli Vijay, Meharwal Zile Singh, Mishra Yugal, Sharma Vijay Kumar, Mishra Manisha
Escorts Heart Institute and Research Centre, New Delhi, India.
J Card Surg. 2003 Mar-Apr;18(2):114-20. doi: 10.1046/j.1540-8191.2003.02010.x.
This is a retrospective study of left ventricle (LV) aneurysm repair done at the Escorts Heart Institute and Research Centre, New Delhi, since October 1988. Two methods of LV aneurysm repair are practiced: double breasting (DB) and Dor's repair. The method varies with location, size, and extent of aneurysm and quality of the fibrotic wall of the aneurysm.
Between October 1988 and May 2001, 129 patients underwent LV aneurysm repair using one of the two techniques; 78 patients had Dor's repair while 51 patients had DB repair.
Overall mortality was 2.3% (three patients). One patient died in the DB group, and two patients died in the Dor's repair group. Mean preoperative ejection fraction (EF) after surgery in DB was 31% while in Dor's repair it was 29.2%. EF showed improvement after surgery to 48.5% in DB and 46.6% in Dor's repair. Decrease in end-diastolic volume (EDV) in DB was from 146 to 91.4 cm3/m2, and in Dor's repair it was from 156 cm3/m2 to 88.6 cm3/m2. Decrease in end-systolic volume was from 101 cm3/m2 to 60.2 cm3/m2 in DB and from 109 cm3/m2 to 64.5 cm3/m2 in Dor's group. All of these values showed statistically significant improvement. At six months postoperatively, 83 patients (74.1%) out of 112 patients who were preoperatively in New York Heart Association (NYHA) Functional Classes III and IV improved to class II while 7 patients (6.3%) improved to class I.
In our experience Dor's repair is indicated for anteroseptal and apical isolated posterior aneurysm to restore LV volume and geometry while DB is indicated for apical, anterolateral, and lateral aneurysms where septal involvement is less. These two techniques have definite indications and advantages with good results.
这是一项对1988年10月以来在新德里 Escorts 心脏研究所和研究中心进行的左心室（LV）动脉瘤修复手术的回顾性研究。LV动脉瘤修复有两种方法：双乳法（DB）和 Dor 修复术。方法因动脉瘤的位置、大小、范围以及动脉瘤纤维化壁的质量而异。
1988年10月至2001年5月期间，129例患者采用这两种技术之一进行了LV动脉瘤修复；78例患者接受了Dor修复术，51例患者接受了DB修复术。
总体死亡率为2.3%（3例患者）。DB组1例患者死亡，Dor修复术组2例患者死亡。DB术后平均术前射血分数（EF）为31%，而Dor修复术为29.2%。术后EF在DB组提高到48.5%，在Dor修复术组提高到46.6%。DB组舒张末期容积（EDV）从146降至91.4cm³/m²，Dor修复术组从156cm³/m²降至88.6cm³/m²。收缩末期容积在DB组从101cm³/m²降至60.2cm³/m²，在Dor组从109cm³/m²降至64.5cm³/m²。所有这些值均显示出统计学上的显著改善。术后6个月，术前纽约心脏协会（NYHA）功能分级为III级和IV级的112例患者中，83例（74.1%）改善为II级，7例（6.3%）改善为I级。
根据我们的经验，Dor修复术适用于前间隔和心尖孤立性后动脉瘤，以恢复LV容积和几何形状，而DB适用于间隔受累较少的心尖、前外侧和外侧动脉瘤。这两种技术有明确的适应证和优势，效果良好。
