Ronco Daniele, Matteucci Matteo, Massimi Giulio, Lodo Vittoria, Garis Sara, Scarantino Arianna, Messina Corinne, Francica Alessandra, Russo Marco, Lorusso Roberto, Barili Fabio, Parolari Alessandro
S.C. Cardiochirurgia e Trapianto di Cuore, Dipartimento Cardiotoracovascolare, ASST Grande Ospedale Metropolitano Niguarda, Milano.
S.C. Cardiochirurgia, Dipartimento Cardio-Toraco-Vascolare, ASST dei Sette Laghi, Varese.
G Ital Cardiol (Rome). 2024 Sep;25(9):615-623. doi: 10.1714/4318.43036.
Left ventricular free wall rupture, ventricular pseudoaneurysm, papillary muscle rupture and ventricular septal rupture are life-threatening mechanical complications of acute myocardial infarction. Despite significant improvements over the last decades in overall mortality for patients with myocardial infarction, the outcome of subjects who develop post-infarction mechanical complications remains poor. Surgical treatment is considered the standard of care. However, percutaneous approaches (such as pericardial fibrin-glue injection for left ventricular free wall rupture, transcatheter edge-to-edge mitral repair for papillary muscle rupture and device closure for ventricular pseudoaneurysm or septal rupture) have been proposed in selected high-risk or inoperable patients, or in subjects with ideal characteristics for feasibility, as therapeutic alternatives to open surgery. The aim of the present review is to provide a comprehensive overview of the percutaneous strategies for the management of post-acute myocardial infarction mechanical complications.
左心室游离壁破裂、室壁假性动脉瘤、乳头肌破裂和室间隔破裂是急性心肌梗死危及生命的机械性并发症。尽管在过去几十年中，心肌梗死患者的总体死亡率有了显著改善，但发生梗死后机械性并发症的患者预后仍然很差。手术治疗被认为是标准的治疗方法。然而，对于部分高危或无法进行手术的患者，或具有理想可行性特征的患者，已提出采用经皮治疗方法（如经皮心包注射纤维蛋白胶治疗左心室游离壁破裂、经导管二尖瓣缘对缘修复治疗乳头肌破裂以及使用装置封堵治疗室壁假性动脉瘤或室间隔破裂）作为开放手术的替代治疗方案。本综述的目的是全面概述经皮治疗策略在急性心肌梗死后机械性并发症管理中的应用。
