Vicol C, Hermann H, Möckl C, Struck E
Herzchirurgische Klinik, Zentralklinikum Augsburg, Germany.
J Cardiovasc Surg (Torino). 1994 Dec;35(6 Suppl 1):63-71.
Among myocardial infarction (MI) secondary complications requiring surgical intervention, the primary sequel is the left ventricular aneurysm (LVA), as a matter of fact, the ventricle septum rupture (VSR) and the moderate to severe ischemic mitral valve regurgitation (IMR) are common as secondary or third follow ones. Between June 1985 and June 1993 in our department, we performed 6418 operations with the support of the heart-lung-machine. This number includes 74 (1.15%) operations of MI complications; 38 interventions because of LVA, 18 operations because of IMR and 18 surgical corrections of VSR. In the great majority of cases a myocardial revascularization was performed simultaneously. Preoperatively the distribution of the whole patient population according to the functional NYHA classification was as follows: NYHA class I: 0, class II: 0, class III: 36 (48.6%), class IV: 27 patients (36.5%) and cardiogenic shock: 11 patients (14.9%). LVA surgery consists in aneurysmectomy and linear closure or endoventricular patch reconstruction, VSR was closed with synthetic patch material and the correction of IMR was performed mainly through partial resection and replacement with a prosthetic valve. Our early mortality was 13.1% for the LVA, 38.8% for the VSR and 11.1% for the IMR patient population, which was congruent with the rates quoted in current literature. The patient follow-up was done within a period of 6 to 90 months after discharge and the available results are very good. Late mortality was 15%. The actuarial survival rat after 7 years was 85% for the LVA, 82% for the VSR and 87% for the IMR patient population.(ABSTRACT TRUNCATED AT 250 WORDS)
在需要手术干预的心肌梗死（MI）继发性并发症中，主要后遗症是左心室动脉瘤（LVA），事实上，室间隔破裂（VSR）和中重度缺血性二尖瓣反流（IMR）作为继发性或第三次随访的并发症也很常见。1985年6月至1993年6月期间，我们科室在心肺机支持下进行了6418例手术。这个数字包括74例（1.15%）MI并发症手术；38例因LVA进行的干预，18例因IMR进行的手术以及18例VSR的外科矫正。在绝大多数情况下，同时进行了心肌血运重建。术前，根据纽约心脏协会（NYHA）功能分级，整个患者群体的分布如下：NYHA I级：0例，II级：0例，III级：36例（48.6%），IV级：27例患者（36.5%），心源性休克：11例患者（14.9%）。LVA手术包括动脉瘤切除术和线性闭合或心室内补片重建，VSR用合成补片材料闭合，IMR的矫正主要通过部分切除并用人工瓣膜置换进行。我们的早期死亡率在LVA患者中为13.1%，VSR患者中为38.8%，IMR患者中为11.1%，这与当前文献引用的比率一致。患者在出院后6至90个月内进行随访，现有结果非常好。晚期死亡率为15%。LVA患者群体7年后的精算生存率为85%，VSR患者为82%，IMR患者为87%。（摘要截选至250字）
