Aravot D J, Dhalla N, Banner N R, Mitchell A, Rees A
Thoracic and Cardiac Surgical Unit, Harefield Hospital, Middlesex, England.
J Thorac Cardiovasc Surg. 1989 Jun;97(6):815-20.
The combination of septal perforation and cardiac rupture after myocardial infarction has rarely been reported. This article describes two cases of successful surgical repair of this condition and reviews another three cases previously reported in the literature. The important clinical features were as follows: (1) acute occlusion of a single dominant coronary artery; (2) renewed chest pain before perforation or rupture; (3) electromechanical dissociation at the time of frank rupture; (4) rupture through the left ventricular free wall; (5) in three patients both complications occurred within 3 days of the infarction, and in the other two patients they developed within three weeks. The main surgical considerations are as follows: (1) femoral cannulation to prevent exsanguination before instituting cardiopulmonary bypass; (2) electrically induced fibrillation to avoid systemic embolism; (3) a left ventricular approach to repair the septal perforation followed by infarctectomy; (4) concomitant revascularization was unnecessary. In conclusion, combined septal perforation and cardiac rupture after myocardial infarction is a potentially correctable condition that requires early diagnosis and prompt surgical intervention.
心肌梗死后合并室间隔穿孔和心脏破裂的情况鲜有报道。本文描述了两例成功进行手术修复的该病症病例，并回顾了文献中先前报道的另外三例病例。重要的临床特征如下：（1）单支优势冠状动脉急性闭塞；（2）穿孔或破裂前再次出现胸痛；（3）明显破裂时出现电机械分离；（4）破口位于左心室游离壁；（5）三名患者的两种并发症均发生在梗死3天内，另外两名患者则在三周内出现。主要的手术考量如下：（1）股动脉插管以防止在建立体外循环前失血；（2）电诱导纤颤以避免全身栓塞；（3）经左心室途径修复室间隔穿孔，随后进行梗死心肌切除术；（4）无需同期进行血运重建。总之，心肌梗死后合并室间隔穿孔和心脏破裂是一种潜在可纠正的病症，需要早期诊断和及时的手术干预。
