Ito Toshiaki, Hagiwara Hiroaki, Maekawa Atsuo
Department of Cardiovascular Surgery, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura, Nagoya, Japan.
Gen Thorac Cardiovasc Surg. 2012 Aug;60(8):475-9. doi: 10.1007/s11748-012-0084-5. Epub 2012 Jun 12.
Surgical results for post-infarction ventricular septal rupture (VSR) remain poor, even today. The aim of this study was the establishment and clinical evaluation of a simple, standardized septal patch technique for this disease.
From 1999 to 2011, 16 consecutive patients with a mean age of 73.1 ± 10.1 (range 55-89) underwent emergency repair of VSR following anterior myocardial infarction. Entire septal patch technique, in which a large pericardial patch is fixed reciprocally between transmural sutures placed in the posterior free wall adjacent to the ventricular septum and anterior left ventriculotomy closing sutures, thus almost entirely covering the septal wall, was used in all cases.
Mean interval between the onset of septal rupture and surgery was 1.3 ± 0.6 (range 1-3) days. Eight patients presented cardiogenic shock and 14 patients underwent preoperative intra-aortic balloon pumping. Average operation, cardiopulmonary bypass, and aortic clamp time were 233 ± 71 (145-360), 128 ± 51 (82-240), and 46 ± 15 (29-76) min, respectively. Coronary artery bypass grafting was performed concomitantly in five cases. Average intra-operative blood loss was 340 ± 184 (123-740) g. Thirty-day mortality was 0 %, and in-hospital mortality was 13.3 % (2/16). Significant residual shunt occurred in one patient. All hospital survivors were followed up with a mean period of 44.5 ± 40 (5-131) months. Five-year survival of all operated patients was 69 ± 14 %.
Entire septal patch technique proved to be an easily reproducible method for anterior VSR that demonstrated stable early and late results.
即使在当今，心肌梗死后室间隔破裂（VSR）的手术效果仍然很差。本研究的目的是建立并临床评估一种针对该疾病的简单、标准化的间隔补片技术。
1999年至2011年，16例平均年龄为73.1±10.1岁（范围55 - 89岁）的患者在急性前壁心肌梗死后接受了VSR急诊修复术。所有病例均采用全间隔补片技术，即通过将一个大的心包补片相互固定在与室间隔相邻的后壁经壁缝线和左心室前壁切开闭合缝线之间，从而几乎完全覆盖间隔壁。
间隔破裂至手术的平均间隔时间为1.3±0.6天（范围1 - 3天）。8例患者出现心源性休克，14例患者术前行主动脉内球囊反搏。平均手术时间、体外循环时间和主动脉阻断时间分别为233±71分钟（145 - 360分钟）、128±51分钟（82 - 240分钟）和46±15分钟（29 - 76分钟）。5例患者同时行冠状动脉旁路移植术。术中平均失血量为340±184克（123 - 740克）。30天死亡率为0%，住院死亡率为13.3%（2/16）。1例患者出现明显残余分流。所有住院幸存者均接受了平均44.5±40个月（5 - 131个月）的随访。所有手术患者的5年生存率为69±14%。
全间隔补片技术被证明是一种易于重复操作的治疗前壁VSR的方法，早期和晚期结果均稳定。
