采用梗死灶封堵技术修复心肌梗死后室间隔破裂：早期结果

Lafci Banu, Yakut Necmettin, Göktogan Tayfun, Ozsöyler Ibrahim, Emrecan Bilgin, Yasa Haydar, Besir Yüksel, Gürbüz Ali

Department of Cardiovascular Surgery, Atatürk Training and Research Hospital, Izmir, Turkey.

Heart Surg Forum. 2006;9(4):E737-40. doi: 10.1532/HSF98.20061043.

BACKGROUND

Ventricular septal rupture is a rare but life-threatening complication of acute myocardial infarction. The mortality rate with medical treatment is more than 90%, whereas the mortality rate after surgical repair varies between 19% and 60% in different studies. This study reviews our experience based on early closure of the septal rupture with an infarct-exclusion technique.

METHODS

Eighteen consecutive patients who underwent post-infarct ventricular septal rupture operation between June 1, 2000, and November 1, 2005, were included in the study. There were 12 male and 6 female patients. Mean age was 65.72 +/- 5.21 years. All patients had echocardiography and coronary angiography before the operation. Rupture was closed with an infarct-exclusion technique in all patients. Preoperative, operative, and postoperative information were collected from patient cohorts.

RESULTS

The median time from myocardial infarction to diagnosis of the ventricular septal rupture was 4.22 +/- 1.61 days. Fourteen of the patients had intra-aortic balloon pump support, and 5 had mechanic ventilator support preoperatively. Surgical repair was done 1 to 4 days after the diagnosis. Ten anterior and 8 posterior ventricular septal ruptures were found. Additional coronary artery bypass surgery was performed with a median of 1.27 +/- 0.8 grafts in 15 (83.3%) patients. The mean postoperative mechanic ventilator support time was 34.13 +/- 45.11 hours. Overall 30-day mortality was 16.7% with 3 patients. The mean intensive care unit stay was 3.3 +/- 1.6 days. Postoperative transthoracic echocardiography showed minimal residual shunts in 4 patients.

CONCLUSION

Patch closure of the ventricular septal rupture with an infarct-exclusion technique provided acceptable results. Concomitant coronary artery bypass grafting might be beneficial to control additional risk of an associated coronary artery lesion. Prompt diagnosis followed by early surgical intervention is essential for patients with ventricular septal rupture.

背景

室间隔破裂是急性心肌梗死一种罕见但危及生命的并发症。药物治疗的死亡率超过90%，而不同研究中手术修复后的死亡率在19%至60%之间。本研究基于采用梗死灶切除术早期闭合室间隔破裂来回顾我们的经验。

方法

本研究纳入了2000年6月1日至2005年11月1日期间连续18例接受心肌梗死后室间隔破裂手术的患者。其中男性12例，女性6例。平均年龄为65.72±5.21岁。所有患者术前均进行了超声心动图和冠状动脉造影检查。所有患者均采用梗死灶切除术闭合破裂口。从患者队列中收集术前、术中及术后信息。

结果

从心肌梗死到诊断室间隔破裂的中位时间为4.22±1.61天。14例患者术前接受了主动脉内球囊泵支持，5例患者术前接受了机械通气支持。诊断后1至4天进行了手术修复。发现10例前室间隔破裂和8例后室间隔破裂。15例（83.3%）患者同时进行了冠状动脉旁路移植术，平均移植1.27±0.8支血管。术后平均机械通气支持时间为34.13±45.11小时。30天总死亡率为16.7%，有3例患者死亡。平均重症监护病房住院时间为3.3±1.6天。术后经胸超声心动图显示4例患者残余分流极小。