Ogiwara M, Kyo S, Yokote Y, Kimura S, Ueda K, Asano H, Hatanaka M, Hirata I, Shimamura Y, Omoto R
First Department of Surgery, Saitama Medical School, Japan.
Kyobu Geka. 1995 Apr;48(4):286-9.
We have treated 10 patients of left ventricular free wall rupture (LVFWR) resulting from acute myocardial infarction (AMI) in our intensive care unit (ICU) from Oct. 1984 to Dec. 1993. Nine of 10 patients underwent surgical repair, however, one patient was treated with pericardocentetesis in ICU and fibrin-glue was infused into the pericardial space (fibrin-glue therapy:FG therapy). The survival rate of surgical repair was only 33% (3/9), especially that was only 17% (1/6) when cardiopulmonary bypass (CPB) was required. One patient (49-year-old, male) suffered from cardiogenic shock following AMI in the posterior wall was performed coronary angioplasty (PTCA) in emergency and IABP support was required. Fourth day after PTCA, a sudden hemodynamical collapse had occurred on this patient due to cardiac tamponade. This patient was treated with pericardiocentetesis in ICU and FG therapy was performed, because all surgical teams were occupied in their operations. After FG therapy hemodynamical stability was obtained, the patient was survived and discharged at 2 months after LVFWR. In conclusion, the surgical result of LVFWR is still not good, especially when CPB was utilized. FG therapy was successful in one patient, suggesting FG therapy can be an alternative therapy for LVFWR when surgical team is not available.
1984年10月至1993年12月期间，我们在重症监护病房（ICU）治疗了10例因急性心肌梗死（AMI）导致的左心室游离壁破裂（LVFWR）患者。10例患者中有9例行手术修复，然而，有1例患者在ICU接受了心包穿刺术，并在心包腔内注入了纤维蛋白胶（纤维蛋白胶治疗：FG治疗）。手术修复的存活率仅为33%（3/9），尤其是在需要体外循环（CPB）时，存活率仅为17%（1/6）。1例（49岁，男性）后壁AMI后发生心源性休克的患者在急诊时进行了冠状动脉血管成形术（PTCA），并需要主动脉内球囊反搏（IABP）支持。PTCA术后第四天，该患者因心脏压塞突然出现血流动力学崩溃。由于所有手术团队都在忙于手术，该患者在ICU接受了心包穿刺术并进行了FG治疗。FG治疗后获得了血流动力学稳定，患者存活并在LVFWR后2个月出院。总之，LVFWR的手术效果仍然不佳，尤其是在使用CPB时。FG治疗在1例患者中取得成功，表明当没有手术团队时，FG治疗可以作为LVFWR的替代治疗方法。
