Atik Fernando A, Navia Jose L, Vega Pablo Ruda, Gonzalez-Stawinski Gonzalo V, Alster Joan M, Gillinov A Marc, Svensson Lars G, Pettersson B Gösta, Lytle Bruce W, Blackstone Eugene H
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Ann Thorac Surg. 2007 Feb;83(2):526-31. doi: 10.1016/j.athoracsur.2006.06.080.
Left ventricular pseudoaneurysm from myocardial infarction is rare and is associated with a high risk of rapid enlargement and rupture. The purposes of this study were to describe its clinical presentation, assess the accuracy of diagnostic imaging modalities, and determine operative and late surgical results.
From January 1986 through December 2001, 30 patients aged 50 to 85 years (mean, 68; 70% male) underwent left ventricular pseudoaneurysm repair. Two surgical approaches were used: primary repair (n = 5, 17%) and patch closure (n = 25, 83%). Twenty-one patients (70%) had concomitant procedures, including coronary revascularization (n = 17, 57%) and mitral valve surgery (n = 9, 30%); 8 patients (29%) underwent emergent surgery. Clinical presentation, preoperative imaging data, and surgical outcomes were abstracted from medical records or obtained by patient follow-up.
The most common clinical presentations were heart failure (n = 22, 73%) and angina (n = 11, 41%). Pseudoaneurysm was rarely suspected at clinical presentation. Contrast ventriculography was diagnostic in 54% of patients in whom it was performed, as opposed to 97% for two-dimensional echocardiography (p = 0.2). Postoperative intra-aortic balloon pump was required in 7 patients (23%). Hospital mortality was 20%, and late survival was 73%, 59%, and 45% at 1, 5, and 8 years, respectively.
Left ventricular pseudoaneurysm should be suspected in postinfarction patients with unexplained heart failure. Echocardiography is usually diagnostic and is superior to ventriculography. The surgical mortality rate is elevated in this complex patient population. Long-term survival is also poor, mainly because of underlying ischemic cardiomyopathy.
心肌梗死所致左心室假性动脉瘤较为罕见，且与快速扩大和破裂的高风险相关。本研究的目的是描述其临床表现，评估诊断性成像方式的准确性，并确定手术及后期手术结果。
1986年1月至2001年12月，30例年龄在50至85岁（平均68岁；70%为男性）的患者接受了左心室假性动脉瘤修复术。采用了两种手术方法：一期修复（n = 5，17%）和补片闭合（n = 25，83%）。21例患者（70%）接受了同期手术，包括冠状动脉血运重建（n = 17，57%）和二尖瓣手术（n = 9，30%）；8例患者（29%）接受了急诊手术。从病历中提取临床表现、术前成像数据及手术结果，或通过患者随访获得。
最常见的临床表现为心力衰竭（n = 22，73%）和心绞痛（n = 11，41%）。临床表现时很少怀疑有假性动脉瘤。对比心室造影在进行该项检查的患者中诊断率为54%，而二维超声心动图为97%（p = 0.2）。7例患者（23%）术后需要主动脉内球囊反搏。医院死亡率为20%，1年、5年和8年的后期生存率分别为73%、59%和45%。
心肌梗死后出现不明原因心力衰竭的患者应怀疑有左心室假性动脉瘤。超声心动图通常可作出诊断，且优于心室造影。在这一复杂患者群体中手术死亡率升高。长期生存率也较低，主要是由于潜在的缺血性心肌病。
