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左心室游离壁破裂修复术后假性动脉瘤切除术:一例报告

Pseudoaneurysmectomy After Left Ventricular Free Wall Rupture Repair: A Case Report.

作者信息

Baldan B Ufuk, Klein Patrick, Stöger J Lauran, Klautz Robert J M, Palmen Meindert

机构信息

Department of Cardiothoracic Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands.

Department of Cardiothoracic Surgery, Leids University Medical Center, 2333 ZA Leiden, The Netherlands.

出版信息

J Clin Med. 2025 May 13;14(10):3393. doi: 10.3390/jcm14103393.

Abstract

: Left ventricular (LV) pseudoaneurysm is a rare but life-threatening complication after acute myocardial infarction, often resulting from inadequate excision of damaged myocardium and use of only a xenopericardial patch during primary LV free wall rupture repair. : A 62-year-old female developed a giant LV pseudoaneurysm one year after initial surgical repair of a free wall rupture with a xenopericardial patch. Imaging confirmed a large pseudoaneurysm with a broad neck and mural thrombus. She underwent pseudoaneurysmectomy, LV reconstruction with a Dacron patch overlaid by a xenopericardial patch, and concomitant mitral and tricuspid valve repair. : Surgical exploration revealed a broad-necked pseudoaneurysm and dehisced patch material. The aneurysm was resected, and the LV was reconstructed, resulting in the exclusion of the pseudoaneurysm and improvement of the shape and function. The patient recovered uneventfully and was discharged in good clinical condition with restored LV function. : Pseudoaneurysm formation after LV free wall rupture repair is often due to insufficient resection and the use of only a xenopericardial patch. Surgical management with complete excision, Dacron patch reconstruction, and xenopericardial reinforcement facilitates the favorable remodeling of LV geometry and function, and reduces the risk of recurrence.

摘要

左心室假性动脉瘤是急性心肌梗死后一种罕见但危及生命的并发症,通常是由于在初次左心室游离壁破裂修复过程中受损心肌切除不充分以及仅使用了异种心包补片所致。

一名62岁女性在初次使用异种心包补片对游离壁破裂进行手术修复一年后出现巨大左心室假性动脉瘤。影像学检查证实存在一个宽颈且伴有壁血栓的大假性动脉瘤。她接受了假性动脉瘤切除术、用涤纶补片覆盖异种心包补片进行左心室重建以及同期二尖瓣和三尖瓣修复。

手术探查发现一个宽颈假性动脉瘤和裂开的补片材料。切除动脉瘤并重建左心室,从而排除了假性动脉瘤并改善了形状和功能。患者恢复顺利,出院时临床状况良好,左心室功能恢复。

左心室游离壁破裂修复后假性动脉瘤形成通常是由于切除不充分以及仅使用了异种心包补片。采用完全切除、涤纶补片重建和异种心包加固的手术管理有助于左心室几何形状和功能的良好重塑,并降低复发风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/909b/12111951/6bcad64cb963/jcm-14-03393-g001.jpg

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