Iwaki Ryuma, Nakagiri Keitaro, Murakami Hirohisa, Morimoto Naoto, Yoshida Masato, Mukohara Nobuhiko
Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan.
J Card Surg. 2014 Mar;29(2):181-5. doi: 10.1111/jocs.12262. Epub 2013 Dec 3.
Repair of a postinfarction ventricular septal defect (VSD) is a challenging procedure with a high risk of postoperative residual shunt and subsequent mortality. This retrospective study aimed to assess a modified infarct exclusion technique with a biventricular approach.
Nineteen consecutive patients who underwent the infarct exclusion procedure for VSD between 2002 and 2011 were reviewed. A biventricular approach (B group: 6 patients) and a left ventricular approach (L group: 13 patients) were studied by univariate analysis.
The overall 30-day mortality was 15.8%, and was not different between the two groups (p=0.94). Postoperative residual shunt was not observed in the B group (p=0.21). The overall five-year survival rate was 79%, and there were no late deaths in the B group (p=0.14).
The repair of postinfarction VSD can be safely performed by the infarct exclusion technique with a biventricular approach. This technique seems to reduce surgical mortality and prevents recurrence of the VSD.
修复心肌梗死后室间隔缺损（VSD）是一项具有挑战性的手术，术后残余分流及后续死亡率风险较高。本回顾性研究旨在评估采用双心室入路的改良梗死灶切除术。
回顾了2002年至2011年间连续19例行VSD梗死灶切除术的患者。通过单因素分析对双心室入路组（B组：6例患者）和左心室入路组（L组：13例患者）进行研究。
总体30天死亡率为15.8%，两组之间无差异（p = 0.94）。B组未观察到术后残余分流（p = 0.21）。总体五年生存率为79%，B组无晚期死亡病例（p = 0.14）。
采用双心室入路的梗死灶切除术可安全地修复心肌梗死后VSD。该技术似乎可降低手术死亡率并防止VSD复发。
