Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Desk J2-3, Cleveland, OH 44195, USA.
Cardiothoracic Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA.
Eur Heart J. 2014 Aug 14;35(31):2060-8. doi: 10.1093/eurheartj/ehu248. Epub 2014 Jun 26.
Ventricular septal rupture (VSR) after acute myocardial infarction is increasingly rare in the percutaneous coronary intervention era but mortality remains high. Prompt diagnosis is key and definitive surgery, though challenging and associated with high mortality, remains the treatment of choice. Alternatively, delaying surgery in stable patients may provide better results. Prolonged medical management is usually futile, but includes afterload reduction and intra-aortic balloon pump placement. Using full mechanical support to delay surgery is an attractive option, but data on success is limited to case reports. Finally, percutaneous VSR closure may be used as a temporizing measure to reduce shunt, or for patients in the sub-acute to chronic period whose comorbidities preclude surgical repair.
急性心肌梗死后室间隔破裂（VSR）在经皮冠状动脉介入治疗时代越来越少见，但死亡率仍然很高。及时诊断是关键，虽然确定性手术具有挑战性且死亡率高，但仍是首选治疗方法。或者，对稳定的患者延迟手术可能会带来更好的结果。延长药物治疗通常是无效的，但包括降低后负荷和主动脉内球囊泵放置。使用完全机械支持来延迟手术是一个有吸引力的选择，但关于成功的数据仅限于病例报告。最后，经皮 VSR 封堵术可作为一种临时措施，以减少分流，或用于亚急性至慢性期的患者，其合并症排除手术修复。
