Canovas Sergio J, Lim Eric, Dalmau Maria J, Bueno Maria, Buendía Jose, Hornero Fernando, Gil Oscar, Garcia Rafael, Paya Rafael, Perez Jose, Echanove Ildefonso, Montero Jose
Department of Cardiac Surgery, University General Hospital, Valencia, Spain.
Circulation. 2003 Sep 9;108 Suppl 1:II237-40. doi: 10.1161/01.cir.0000089042.80722.7a.
Left ventricular free wall rupture (LVFWR) is a dramatic complication after myocardial infarction. We present our mid-term clinical and echocardiographic results of LVFWR with an epicardial patch without cardiopulmonary bypass.
From February 1993 to May 2001, 17 patients underwent surgery for LVFWR. The mean age+/-SD of 12 males and 5 females was 68+/-10 years. All patients presented for emergency surgery with cardiac tamponade confirmed on echocardiography. After opening the chest and identification of the site of rupture, a Goretex patch was fashioned and applied with enbucrilate surgical glue.
Effective control of bleeding was achieved in all cases. There were no on-table deaths. The operative (30 day) mortality was 23.5% (4/17). One death occurred because of patch failure, two because of cardiogenic shock, and one from pneumonia. On follow-up at a median of 2.2 years (interquartile range, 1.1 to 4.3 years), two further deaths occurred, one from myocardial infarction and another of undetermined etiology. Echocardiography did not reveal any evidence of restriction to left ventricular free wall motion.
Patch glue repair is expedient, simple and effective; with no adverse effects on mid-term ventricular dynamics. In view of superior published results to infarctectomy and repair with extra corporeal circulation, it should be considered to be the initial procedure of choice for the surgical repair of LVFWR.
左心室游离壁破裂（LVFWR）是心肌梗死后一种严重的并发症。我们展示了采用心外膜补片且无需体外循环治疗LVFWR的中期临床和超声心动图结果。
1993年2月至2001年5月，17例患者接受了LVFWR手术。12例男性和5例女性的平均年龄±标准差为68±10岁。所有患者均因超声心动图证实的心包填塞而接受急诊手术。打开胸腔并确定破裂部位后，制作一个戈尔特斯补片，并用恩布酯手术胶水粘贴。
所有病例均有效控制了出血。术中无死亡病例。手术（30天）死亡率为23.5%（4/17）。1例死亡是由于补片失败，2例是由于心源性休克，1例是由于肺炎。中位随访2.2年（四分位间距，1.1至4.3年）时，又有2例死亡，1例死于心肌梗死，另1例病因不明。超声心动图未显示左心室游离壁运动受限的任何证据。
补片胶水修复方便、简单且有效；对中期心室动力学无不良影响。鉴于其公布的结果优于梗死切除术和体外循环修复，应考虑将其作为LVFWR手术修复的首选初始方法。
