Matteucci Matteo, Ronco Daniele, Massimi Giulio, Di Mauro Michele, Lorusso Roberto
S.C. Cardiochirurgia, Dipartimento di Medicina e Chirurgia, ASST Sette Laghi, Università degli Studi dell'Insubria, Varese - Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Olanda.
S.C. Cardiochirurgia, Dipartimento di Medicina e Chirurgia, ASST Sette Laghi, Università degli Studi dell'Insubria, Varese - U.O. Cardiochirurgia, Dipartimento Cardiotoracovascolare, ASST Grande Ospedale Metropolitano Niguarda, Milano.
G Ital Cardiol (Rome). 2022 Mar;23(3):190-199. doi: 10.1714/3751.37338.
Post-infarction mechanical complications include left ventricular free-wall rupture, ventricular septal rupture, and papillary muscle rupture. With the advent of early reperfusion strategies, including thrombolysis and percutaneous coronary intervention, these events now occur in fewer than 0.3% of patients following acute myocardial infarction. However, unfortunately, there has been no parallel decrease in associated mortality rates over the past two decades. Moreover, during the ongoing COVID-19 pandemic the incidence of mechanical complications resulting from ST-elevation myocardial infarction has possibly risen. Early diagnosis and prompt management are crucial to improving outcomes. Although some percutaneous device repair approaches are available, surgical treatment remains the gold standard for these catastrophic post-infarction complications. The timing of surgery, also related to the type of complication and patient's clinical conditions, and the possible role of mechanical circulatory supports before and after surgery, represent main topics of debate that still need to be fully addressed.
心肌梗死后机械性并发症包括左心室游离壁破裂、室间隔破裂和乳头肌破裂。随着早期再灌注策略的出现，包括溶栓和经皮冠状动脉介入治疗，这些事件目前在急性心肌梗死后患者中的发生率不到0.3%。然而，不幸的是，在过去二十年中，相关死亡率并未相应下降。此外，在持续的COVID-19大流行期间，ST段抬高型心肌梗死导致的机械性并发症发生率可能有所上升。早期诊断和及时处理对于改善预后至关重要。虽然有一些经皮装置修复方法，但手术治疗仍然是这些灾难性心肌梗死后并发症的金标准。手术时机，也与并发症类型和患者临床状况有关，以及手术前后机械循环支持的可能作用，是仍需充分探讨的主要争议话题。
