Noguchi Kenichiro, Yamaguchi Atsushi, Naito Kazuhiro, Yuri Kouichi, Adachi Hideo
Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan.
Gen Thorac Cardiovasc Surg. 2012 May;60(5):261-7. doi: 10.1007/s11748-011-0882-1. Epub 2012 Mar 28.
Ventricular septal perforation represents a serious complication after acute myocardial infarction. This study aimed to evaluate the short-term and longterm outcomes of postinfarction ventricular septal perforation (VSP).
We evaluated outcomes for VSP repair for 42 patients over 19 years. A retrospective analysis of clinical records, risk factors for hospital death, and long-term survival was performed.
In-hospital mortality was 33.3%. The most common cause of hospital death was left-sided heart failure. A low ejection fraction and short time interval from acute myocardial infarction to the onset of VSP were significant risk factors. The actuarial survival rates of in-hospital survivors at 5 and 10 years were 81.7% and 43.5%, respectively. There were 17 cardiac events among the survivors during the follow-up period. The most influential factor affecting long-term outcomes was the number of diseased coronary arteries.
The long-term survival outcome of VSP patients during the postoperative period was comparatively good, but the prognosis of VSP patients with multivessel disease was not satisfactory because of congestive heart failure or ventricular arrhythmia. We believe that postoperative medical treatment for preventing cardiac remodeling is important for improving long-term survival outcomes in such patients.
室间隔穿孔是急性心肌梗死后的一种严重并发症。本研究旨在评估心肌梗死后室间隔穿孔（VSP）的短期和长期预后。
我们评估了19年间42例VSP修复患者的预后。对临床记录、医院死亡危险因素和长期生存情况进行了回顾性分析。
院内死亡率为33.3%。医院死亡的最常见原因是左侧心力衰竭。低射血分数以及从急性心肌梗死到VSP发作的时间间隔短是显著的危险因素。院内幸存者5年和10年的精算生存率分别为81.7%和43.5%。随访期间幸存者中有17例发生心脏事件。影响长期预后的最主要因素是病变冠状动脉的数量。
VSP患者术后长期生存结果相对较好，但多支血管病变的VSP患者由于充血性心力衰竭或室性心律失常，预后并不理想。我们认为，术后预防心脏重塑的药物治疗对于改善此类患者的长期生存结果很重要。
