Lunkenheimer P P, Redmann K, Kimaun D, Cryer C W, Wübbeling F, Konertz W, Zytowsky A, Hotz H, Ho S Y, Anderson R H
Klinik und Poliklinik für Thorax, Herz und Gefèasschirurgie, University Münster, Germany.
J Card Surg. 2003 May-Jun;18(3):225-35. doi: 10.1046/j.1540-8191.2003.02026.x.
Because of the variation in the surgical procedures designed to reduce ventricular radius, along with differences in hospital care, it is difficult to disentangle the factors that may contribute to the success or failure of the partial left ventriculectomy.
We undertook partial left ventriculectomy in 18 patients, 10 suffering from idiopathic dilated cardiomyopathy and 8 from ischemic heart disease. We assessed the amount of reduction in wall stress, the systolic thickening of the ventricular wall, and the extent of connective tissue in the excised segment of the wall. Of the overall group, six patients died, three from infarction, one of stroke, one with asystole, and one with ventricular fibrillation. The mean decrease in measured mesh tension was 40% (p < 0.001). Most patients exhibited improvements postoperatively in terms of the systolic thickening of the posterior and superior free walls of the left ventricle. In those in whom the events could be monitored, life-threatening arrhythmias posed complications in three of four patients with ischemic heart disease, and in two of six patients suffering from idiopathic dilated cardiomyopathy. In one patient, death was associated with a transmural alignment of fibrous tissue.
Our measured reductions in myocardial mesh tension were in keeping with the anticipated theoretical reduction in wall stress expected from partial ventriculectomy. The basic concept underscoring surgical maneuvers to reduce ventricular radius, therefore, is sound. A potential trap is the resection of the marginal artery. Critical myofibrosis was a rare complication. Arrhythmias, which are common, can successfully be treated by implantation of antitachycardic and defibrillatory devices.
由于旨在减小心室半径的手术操作存在差异，再加上医院护理的不同，很难厘清可能导致部分左心室切除术成败的因素。
我们对18例患者实施了部分左心室切除术，其中10例患有特发性扩张型心肌病，8例患有缺血性心脏病。我们评估了壁应力的降低量、心室壁的收缩增厚情况以及切除的壁段中的结缔组织范围。在整个组中，6例患者死亡，3例死于梗死，1例死于中风，1例死于心搏停止，1例死于心室颤动。测得的网张力平均降低了40%（p < 0.001）。大多数患者术后左心室后游离壁和上游离壁的收缩增厚情况有所改善。在可监测病情的患者中，4例缺血性心脏病患者中有3例出现危及生命的心律失常并发症，6例特发性扩张型心肌病患者中有2例出现该并发症。在1例患者中，死亡与纤维组织的透壁排列有关。
我们测得的心肌网张力降低与部分心室切除术预期的理论壁应力降低相符。因此，强调通过手术操作减小心室半径的基本概念是合理的。一个潜在的陷阱是边缘动脉的切除。严重肌纤维化是一种罕见的并发症。常见的心律失常可通过植入抗心动过速和除颤装置成功治疗。
