Magovern G J, Heckler F R, Park S B, Christlieb I Y, Magovern G J, Kao R L, Benckart D H, Tullis G, Rozar E, Liebler G A
Department of Surgery, Allegheny General Hospital, Pittsburgh, PA 15212.
Ann Thorac Surg. 1987 Oct;44(4):379-88. doi: 10.1016/s0003-4975(10)63797-6.
Two patients are described, each with a large left ventricular aneurysm and severe coronary artery disease, and each with an ejection fraction lower than 30% and in congestive heart failure. In both, the left latissimus dorsi (LD) muscle was used in the repair of the ventricular aneurysm because preoperative studies demonstrated that there was concomitant coronary artery disease, and there was a strong suggestion that resection of the entire aneurysm would seriously compromise the residual ventricular capacity. One patient had an 18-year history of coronary occlusion with two infarctions. A large, calcified ventricular aneurysm developed, and despite vigorous medical treatment, intractable congestive heart failure and angina persisted. The diffuse coronary artery disease made this patient a poor candidate for bypass grafting. The other patient sustained an acute myocardial infarction 5 months prior to operation. The left anterior descending coronary artery was totally occluded, and a large apical aneurysm developed along with an akinetic anterior wall and septum. After his heart attack, the patient had progressive dyspnea on exertion. Following operation in both patients, the transpositioned LD, then a component in the repair of the left ventricular wall, was electrically trained to synchronously contract with each systole, driven by a standard dual-chamber cardiac pacemaker. Steady improvement and a return to normal activities were observed in both patients. There was an indication of improved ejection fraction with synchronous contraction of the skeletal muscle.
本文描述了两名患者，均患有巨大左心室室壁瘤和严重冠状动脉疾病，射血分数均低于30%且处于充血性心力衰竭状态。对于这两名患者，均采用背阔肌（LD）修复心室室壁瘤，因为术前研究表明存在合并冠状动脉疾病，且强烈提示切除整个室壁瘤会严重损害残余心室功能。一名患者有18年冠状动脉闭塞病史，发生过两次心肌梗死。形成了一个巨大的钙化心室室壁瘤，尽管积极进行药物治疗，但顽固性充血性心力衰竭和心绞痛仍持续存在。弥漫性冠状动脉疾病使该患者不适合进行旁路移植术。另一名患者在手术前5个月发生急性心肌梗死。左前降支冠状动脉完全闭塞，同时出现一个巨大的心尖部室壁瘤以及运动不能的前壁和室间隔。心肌梗死后，该患者活动时进行性呼吸困难。两名患者术后，转位后的背阔肌作为左心室壁修复的一部分，由标准双腔心脏起搏器驱动，接受电训练以与每次收缩同步收缩。两名患者均观察到病情稳步改善并恢复正常活动。有迹象表明骨骼肌同步收缩可使射血分数提高。
