Kuraoka S, Nakamura C, Watanabe T, Orita H, Shimanuki T, Shimasaki T, Fukasawa M, Abe H, Iijima Y, Washio M
Second Department of Surgery, Yamagata University School of Medicine.
Kyobu Geka. 1991 Jul;44(8 Suppl):629-35.
Severe type of ventricular arrhythmia was noticed after Cabrol's operation more frequently than usual reperfusion arrhythmia. Nine patients received Cabrol's operation and 2 of Bentall's were divided into 2 groups according to the occurrence of postsurgical ventricular arrhythmia (Lown's classification grade 0-3: 5 cases, grade 4 A-5: 6 cases), and then the factors contributed to the arrhythmia were analyzed. There were no significant differences between the 2 groups on the point of the characteristics of the cases with or without emergent surgery for, such as ruptured or dissecting thoracic aortic aneurysms or other complicated lesions, the degree of surgical damage, or preoperative cardiac function. The only significant difference between the groups was the angle overheading to the central point of left coronary orifice anastomosed with intermediate tube from the extensive line of the prosthetic flange obtained in the left anterior oblique views on the angiography. The mean value of the angle of the severe group (grade 4 A-5) was 41 +/- 6.8 degrees (mean +/- SD) and significantly acute than the angle of the other group (grade 0-3: 57 +/- 6.4 degrees). This fact suggested that the main reason of the ventricular arrhythmia was coronary ischemia caused by compression of the intermediate tube after formation of massive hematoma within the aneurysmal capsule wrapped over the composite graft.
与通常的再灌注性心律失常相比，卡布罗尔手术后更频繁地出现严重类型的室性心律失常。9例患者接受了卡布罗尔手术，2例接受了本塔尔手术的患者根据术后室性心律失常的发生情况（洛恩分类0 - 3级：5例，4A - 5级：6例）分为两组，然后分析导致心律失常的因素。两组在是否有急诊手术指征（如胸主动脉瘤破裂或夹层或其他复杂病变）、手术损伤程度或术前心功能等病例特征方面无显著差异。两组之间唯一显著的差异是在血管造影左前斜位上从人工瓣膜法兰宽线到与中间管道吻合的左冠状动脉口中心点的夹角。重度组（4A - 5级）的角度平均值为41±6.8度（均值±标准差），明显比另一组（0 - 3级：57±6.4度）更尖锐。这一事实表明，室性心律失常的主要原因是包裹在复合移植物上的动脉瘤囊内形成大量血肿后中间管道受压导致的冠状动脉缺血。
