Cummings R G, Reimer K A, Califf R, Hackel D, Boswick J, Lowe J E
Department of Surgery, Duke University Medical Center, Durham, NC 27710.
Circulation. 1988 Jan;77(1):33-42. doi: 10.1161/01.cir.77.1.33.
To quantitate the amount of right and left ventricular infarction in patients dying with postinfarction ventricular septal defect (PIVSD), hearts from 54 patients with anterior or inferior myocardial infarction were studied at autopsy. Fifteen hearts had myocardial infarction with PIVSD and 39 hearts had infarction without PIVSD and were used as a comparison group. All infarcts were sized histologically and the percent of each ventricle infarcted was quantitated by computer-assisted planimetry. The pathologic substrate for PIVSD was diffuse coronary artery disease with acute thrombosis resulting in transmural confluent infarction. Within the PIVSD group, there was significantly more left ventricle involved in anterior infarctions than in inferior infarctions (p less than .04). Conversely, there was more right ventricular infarction in inferiorly located myocardial infarctions with resulting PIVSD (p = .059). When infarctions resulting in PIVSD were compared with infarctions not resulting in PIVSD, the PIVSD group was characterized by larger left and right ventricular infarcts irrespective of infarct location (p less than .003). The incidence of right ventricular infarction was 100% in the PIVSD group (p less than .0001). Twelve of the 15 patients with PIVSD (80%) developed cardiogenic shock within 48 hr of septal rupture. The high incidence of shock and the rapid deterioration may have been secondary to right ventricular infarction in these patients. Therefore, infarcts resulting in PIVSD and subsequent death are characterized by a high incidence of right ventricular infarction. Significantly more infarction of the right ventricle is seen in either anterior or inferior infarctions resulting in PIVSD compared with infarctions not resulting in PIVSD. PIVSD complicating inferior infarctions is associated with the greatest amount of right ventricular infarction.
为了定量分析死于心肌梗死后室间隔缺损（PIVSD）患者的左右心室梗死量，对54例患有前壁或下壁心肌梗死患者的心脏进行了尸检研究。15例心脏有心肌梗死合并PIVSD，39例心脏有梗死但无PIVSD，用作对照组。所有梗死灶均通过组织学测量大小，并通过计算机辅助平面测量法定量每个心室梗死的百分比。PIVSD的病理基础是弥漫性冠状动脉疾病伴急性血栓形成，导致透壁性融合梗死。在PIVSD组中，前壁梗死累及左心室的程度明显高于下壁梗死（p<0.04）。相反，下壁心肌梗死合并PIVSD时右心室梗死更多（p = 0.059）。将导致PIVSD的梗死与未导致PIVSD的梗死进行比较时，PIVSD组的特征是无论梗死部位如何，左右心室梗死灶都更大（p<0.003）。PIVSD组右心室梗死的发生率为100%（p<0.0001）。15例PIVSD患者中有12例（80%）在间隔破裂后48小时内发生心源性休克。这些患者休克的高发生率和快速恶化可能继发于右心室梗死。因此，导致PIVSD并随后死亡的梗死灶的特征是右心室梗死的高发生率。与未导致PIVSD的梗死相比，导致PIVSD的前壁或下壁梗死中右心室梗死明显更多。合并下壁梗死的PIVSD与最大量的右心室梗死相关。
