Fujita Kohei, Fukuhara Toru, Munemasa Mitsuru, Numba Yoichiro, Kuyama Hideyuki
Department of Cardiology, Neuro-research Institute for Stroke Care, National Hospital Organization Okayama Medical Center, Okayama 701-1192, Japan.
Surg Neurol. 2007 Nov;68(5):556-61; discussion 561. doi: 10.1016/j.surneu.2006.11.041.
The authors report 6 cases of aneurysmal SAH associated with ampulla cardiomyopathy, which has been considered a unique type of stunned myocaridum.
All patients were female, ranged from 35 to 79 years, and their echocardiograms revealed typical cardiac wall motions: the hypokinesia in the apical area of the left ventricle associated with the hyperkinesia in the basal area. In all, the cardiac function started to recover in the first few days; however, associated pulmonary congestions delayed aneurysmal surgeries in 3 patients. Among 3 patients whose surgeries were delayed, one died due to rerupture of aneurysm and another due to severe pneumonia. The other 4 patients recovered well, although one had left ventricular mural thrombus, which was treated successively with anticoagulant.
It is considered highly important for neurosurgeons to be familiar with this clinical entity, since this transient cardiac function disturbance can be diagnosed at the initial presentation with a unique wall motion. The significance and clinical features of ampulla cardiomyopathy are discussed.
作者报告了6例与壶腹型心肌病相关的动脉瘤性蛛网膜下腔出血,壶腹型心肌病被认为是一种独特类型的心肌顿抑。
所有患者均为女性,年龄在35至79岁之间,其超声心动图显示典型的心脏壁运动:左心室心尖区运动减弱伴基底区运动增强。总体而言,心脏功能在最初几天开始恢复;然而,3例患者出现的相关肺充血延迟了动脉瘤手术。在手术延迟的3例患者中,1例因动脉瘤再次破裂死亡,另1例因严重肺炎死亡。其他4例患者恢复良好,尽管其中1例有左心室壁血栓,经抗凝治疗后病情好转。
神经外科医生熟悉这一临床实体被认为非常重要,因为这种短暂的心脏功能障碍在初次就诊时可通过独特的壁运动进行诊断。本文讨论了壶腹型心肌病的意义和临床特征。