Endo Masahiro, Kurosawa Hironobu
Department of Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Kyobu Geka. 2004 Jul;57(8 Suppl):690-7.
Left ventricular (LV) free wall rupture is an uncommon but catastrophic event after acute myocardial infarction and is associated with a high mortality. Some patients may be salvaged with emergent operation. Padro et al. described a sutureless technique for the treatment of postinfarction LV free wall rupture. We have adopted a similar sutureless technique using a fibrin glue-oxycellulose fixation.
A review of 32 patients during a 20-year period who were referred to coronary care unit (CCU) with postinfarction LV free wall rupture was conducted. There were 17 men and 15 women with an average age of 68.8 years. Nine patients were treated who having one-stage operation of simultaneous 7 ventricular septal perforation and 2 coronary artery bypass grafting (CABG). Nine patients were sutured directly with a felt sandwich technique with or without cardiopulmonary bypass. Five patients were treated with pericardiectomy and pericardiocentesis using direct vision. Nine patients were sealed with sutureless method using fibrin glue-oxycellurose fixation without cardiopulmonary bypass.
Eleven hospital deaths (34.4%, 11/32) were occurred in the all patints. However, 1 death (7.1%, 1/14) occurred in the pericardiectomy and in the sutureless sealed groups.
A sutureless technique for an oozing type of postinfarction LV free wall rupture is effective.
左心室游离壁破裂是急性心肌梗死后一种罕见但灾难性的事件，死亡率很高。一些患者可通过紧急手术挽救。帕德罗等人描述了一种治疗心肌梗死后左心室游离壁破裂的无缝合技术。我们采用了一种类似的无缝合技术，使用纤维蛋白胶-氧化纤维素固定。
回顾了20年间32例因心肌梗死后左心室游离壁破裂被收入冠心病监护病房（CCU）的患者。其中男性17例，女性15例，平均年龄68.8岁。9例患者接受了同期7例室间隔穿孔和2例冠状动脉旁路移植术（CABG）的一期手术治疗。9例患者采用带或不带体外循环的毡片夹层技术直接缝合。5例患者采用直视下心包切除术和心包穿刺术治疗。9例患者采用纤维蛋白胶-氧化纤维素固定的无缝合方法，无需体外循环进行封闭。
所有患者中有11例（34.4%，11/32）院内死亡。然而，心包切除术组和无缝合封闭组各有1例（7.1%，1/14）死亡。
对于渗血型心肌梗死后左心室游离壁破裂，无缝合技术是有效的。
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