Hutchins G M, Brawley R K
Am J Pathol. 1980 Apr;99(1):221-30.
Operative repair of ventricular aneurysms should improve left ventricular function. Despite its theoretic advantage, the mortality following this operation is high, and many patients have severe postoperative hypotension. The cardiac findings were studied in 18 patients who died after repair of ventricular aneurysms. All hearts were examined at autopsy after postmortem coronary arteriography and fixation in a distended state. Five patients in Group I had intractable fatal postoperative hypotension, 7 in Group II initially had severe hypotension that improved, and 6 in Group III did not have postoperative hypotension. Curvature thickness indexes (CTIs) of the ventricular segments, which correlate with their pressure-producing activity, were determined in the 18 hearts. CTIs for the left ventricular free wall and septum were lower in Group I and Group II patients with hypotension than those in Group III without. The reduced CTIs in patients with postoperative shock appear to arise as a result of ventricular reconstruction that reduces ventricular wall curvature. The authors suggest that left ventricular function after aneurysm resection would be improved by inverting, rather than everting, the edges of the ventriculotomy, thereby increasing wall curvature and the CTI. Noninvasive determinations of the CTI may prove of value in guiding topographic reconstruction of ventricles with aneurysms.
心室壁瘤的手术修复应能改善左心室功能。尽管该手术具有理论上的优势，但其术后死亡率很高，而且许多患者术后会出现严重的低血压。对18例心室壁瘤修复术后死亡的患者的心脏情况进行了研究。所有心脏均在尸检时进行了冠状动脉造影，并在心脏扩张状态下固定后进行检查。第一组有5例患者术后出现顽固性致命性低血压，第二组有7例患者最初有严重低血压但后来有所改善，第三组有6例患者没有术后低血压。在这18颗心脏中测定了与心室节段压力产生活动相关的心室节段曲率厚度指数（CTI）。第一组和第二组有低血压的患者左心室游离壁和室间隔的CTI低于第三组无低血压的患者。术后休克患者CTI降低似乎是由于心室重建导致心室壁曲率降低所致。作者建议，通过将心室切开边缘翻转而非外翻，从而增加心室壁曲率和CTI，可改善动脉瘤切除术后的左心室功能。CTI的无创测定可能对指导有动脉瘤的心室的地形重建具有价值。
