Wang Qiang, Xu Li, Wang Dongjin
Cardiothoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing Jiangsu 210008, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Aug;25(8):998-1000.
To discuss left ventricular reconstruction methods and effectiveness in patients with left ventricular aneurysm after myocardial infarction.
Between June 2003 and August 2008, 23 patients with left ventricular aneurysm after myocardial infarction were treated. Of them, 13 were male and 10 were female with an average age of 61.2 years (range, 47-74 years). According to New York Heart Association (NYHA) criteria for cardiac function, there were 3 cases of grade I, 6 cases of grade II, 10 cases of grade III, and 4 cases of grade IV. The coronary arteriography showed single-vessel disease in 2 cases, double-vessel disease in 5 cases, triple-vessel disease in 16 cases. The locations of ventricular aneurysm were the apex cordis in 18 cases, antetheca and parieslateralis in 4 cases, and interior wall in 1 case. The left ventricular ejection fraction was 36.52% +/- 12.15%, and left ventricular diastolic final diameter was (62.30 +/- 6.52 ) mm. Nine patients received standard linear repair, 6 patients received standard linear repair after endocardial ring shrinkage, and 8 patients received patch suture after endocardial ring shrinkage.
Two cases died perioperatively, and re-thoracotomy was performed to stop bleeding in 1 case. Incisions healed by first intention in the other patients without early complication. Twenty-one patients were followed up 7-48 months (median, 19 months). At 6 months after surgery, the left ventricular ejection fraction 46.52% +/- 9.41% were significantly improved when compared with that at preoperation (t = 2.240, P = 0.023); the left ventricular diastolic final diameter (52.23 +/- 5.11) mm were significantly decreased when compared with that at preoperation (t = 2.170, P = 0.035). The cardiac function according to NYHA criteria was at grade I in 8 cases and at grade II in 13 cases. One patient died of cerebral hemorrhage at 18 months after operation and the activities of daily living recoverd in the others.
Individual therapeutic methods are used according to patients' different conditions for left ventricular aneurysm after myocardial infarction.
探讨心肌梗死后左心室室壁瘤患者左心室重建的方法及疗效。
选取2003年6月至2008年8月期间收治的23例心肌梗死后左心室室壁瘤患者。其中男13例，女10例，平均年龄61.2岁（47 - 74岁）。根据纽约心脏病协会（NYHA）心功能分级标准，Ⅰ级3例，Ⅱ级6例，Ⅲ级10例，Ⅳ级4例。冠状动脉造影显示单支血管病变2例，双支血管病变5例，三支血管病变16例。室壁瘤位于心尖部18例，前壁及侧壁4例，心内膜1例。左心室射血分数为36.52%±12.15%，左心室舒张末期内径为（62.30±6.52）mm。9例行标准线性修复术，6例行心内膜环缩后标准线性修复术，8例行心内膜环缩后补片缝合术。
围手术期死亡2例，1例再次开胸止血。其余患者切口一期愈合，无早期并发症。21例患者获7 - 48个月（中位时间19个月）随访。术后6个月，左心室射血分数为46.52%±9.41%，较术前显著提高（t = 2.240，P = 0.023）；左心室舒张末期内径为（52.23±5.11）mm，较术前显著减小（t = 2.170，P = 0.035）。根据NYHA标准，心功能Ⅰ级8例，Ⅱ级13例。1例患者术后18个月死于脑出血，其余患者日常生活活动能力恢复。
对于心肌梗死后左心室室壁瘤患者，应根据患者不同情况采用个体化治疗方法。
