Coletti G, Torracca L, Zogno M, La Canna G, Lorusso R, Pardini A, Alfieri O
II Division of Cardiac Surgery, Spedali Civili, Brescia, Italy.
Cardiovasc Surg. 1995 Apr;3(2):181-6. doi: 10.1016/0967-2109(95)90891-8.
Left ventricular rupture after acute myocardial infarction occurs more often than suspected and diagnosis is rarely made before death. Left ventricular rupture has been reported to contribute to the overall in-hospital mortality after acute myocardial infarction in up to 24% of cases and to be present in 40% of patients dying within the first week after infarction. Only prompt diagnosis and aggressive surgical treatment can be lifesaving under these circumstances. Between February 1991 and August 1993 five patients underwent emergency operation for left ventricular rupture after acute myocardial infarction using exclusively transoesophageal echocardiography as a diagnostic tool. All patients had evidence of cardiac tamponade and electrocardiography showed signs of anterolateral acute myocardial infarction in one, inferolateral acute myocardial infarction in three and lateral acute myocardial infarction in one. In two cases the infarcted area was debrided and an interrupted pledgetted 2/0 polypropylene suture was placed from inside of the ventricle outward to the epicardial surface and then through the pericardial patch. In the other three cases an original technique was used: an autologous glutaraldehyde-stiffened pericardial patch was sealed over the infarcted area using fibrin glue and fixed with running suture on the surrounding healthy myocardium. One patient died in the operating room because of low cardiac output syndrome which was possibly the result of an excessively extended area of infarction. Left ventricular rupture is a catastrophic complication of acute myocardial infarction and prompt diagnosis with transoesophageal echocardiography followed by emergency operation can be lifesaving.(ABSTRACT TRUNCATED AT 250 WORDS)
急性心肌梗死后左心室破裂的发生率比预想的更高，且很少在死亡前做出诊断。据报道，左心室破裂在急性心肌梗死后的院内总死亡率中所占比例高达24%，在梗死第一周内死亡的患者中占40%。在这种情况下，只有迅速诊断并积极进行手术治疗才能挽救生命。1991年2月至1993年8月期间，有5例急性心肌梗死后左心室破裂的患者接受了急诊手术，仅使用经食管超声心动图作为诊断工具。所有患者均有心脏压塞的证据，心电图显示1例为前侧壁急性心肌梗死，3例为下侧壁急性心肌梗死，1例为侧壁急性心肌梗死。2例患者对梗死区域进行清创，用带垫片的2/0聚丙烯间断缝线从心室内向外穿过至心外膜表面，然后穿过心包补片。另外3例采用了一种新技术：用纤维蛋白胶将自体戊二醛硬化心包补片密封在梗死区域上，并用连续缝线固定在周围健康心肌上。1例患者因低心排血量综合征死于手术室，这可能是梗死面积过大所致。左心室破裂是急性心肌梗死的灾难性并发症，经食管超声心动图迅速诊断后进行急诊手术可挽救生命。（摘要截短至250字）
