Apostolakis Efstratios E, Kallikourdis Antonios, Baikoussis Nikolaos G, Dedeilias Panagiotis, Dougenis Dimitrios
Cardiothoracic Surgery Department, Patras University School of Medicine, 26500 Rion Patras, Greece.
J Cardiothorac Surg. 2010 Feb 19;5:6. doi: 10.1186/1749-8090-5-6.
Patient's myocardium with post-infarction ventricular septum defect (VSD) is characterized by severe dysfunction. The "additive ischemia" caused by the operating process of cross-clamp ischemia and reperfusion injury, has a significant aggravation to the myocardium and overall negative impact to patient's outcome. We present a useful, safe and advantageous methodology in order to abolish "the toxic phase" of ischemia-reperfusion which is adopted by most as the "classic repair method" of myocardial protection. This abolition is in our opinion, particularly beneficial in order to reverse postoperatively the Low Cardiac Output Syndrome (LOS) and achieve better short and long term results. By using this method we avoid the aortic occlusion, the use of systematic hypothermia and any cardioplegic arrest. Furthermore, the total cardio-pulmonary bypass (CPB) time is significantly reduced, tissue debridement and stitching is much easier and safer. We think the method is applicable for every anterior and apical case of post-infarction septum rupture. After application of method in 3 patients with anterior post-myocardial infarction VSD, we are convinced that the patient will have a better postoperative haemodynamic condition and therefore a better outcome.
患有心肌梗死后室间隔缺损（VSD）的患者心肌表现为严重功能障碍。交叉夹闭缺血和再灌注损伤的手术过程所导致的“附加性缺血”，会使心肌显著恶化，并对患者的总体预后产生负面影响。我们提出一种有用、安全且具有优势的方法，以消除缺血再灌注的“毒性期”，而大多数人采用的“经典修复方法”采用的就是这种缺血再灌注。我们认为，这种消除对于术后逆转低心排血量综合征（LOS）并取得更好的短期和长期效果特别有益。通过使用这种方法，我们避免了主动脉阻断、全身低温的使用以及任何心脏停搏。此外，体外循环（CPB）总时间显著缩短，组织清创和缝合更加容易且安全。我们认为该方法适用于心肌梗死后间隔破裂的每一例前壁和心尖病例。在对3例前壁心肌梗死后VSD患者应用该方法后，我们确信患者术后将具有更好的血液动力学状况，从而获得更好的预后。
