Christenson J T, Bloch A, Simonet F, Schmuziger M
Services de chirurgie cardiovasculaire, hôpital de la Tour, Suisse.
Arch Mal Coeur Vaiss. 1996 Dec;89(12):1627-32.
Left ventricular aneurysm (LVA) following myocardial infarction carry a high morbidity and mortality, which may be reduced by appropriate surgical treatment. The Jatene correction is an attractive technique for aneurysm repair. We have employed a modified Jatene correction in 72 patients between July 1986 and May 1995. There were 57 men and 15 women, mean age 61.6 +/- 8.2 years old. Fifteen patients (21%) presented with malignant recurrent ventricular arrhythmias. Fourteen patients had emergency operations and 3 were redo coronary artery bypass grafts. Fifty-eight patients (83%) were in NYHA class III and IV. Fifty-two patients had 3-vessel disease. Preoperative left ventricular ejection fraction (LVEF) was 30.4 +/- 12.2% (10-59%) and left ventricular end-diastolic pressure was 26.2 +/- 10.1 mmHg (12-41 mmHg). The overall perioperative mortality was 11.1%, one patient had a peroperative myocardial infarction. Immediately postoperatively, 17 patients had low cardiac output, requiring intraaortic balloon pump in eight cases. There were no bleeding problems and 30 patients (42%) had no postoperative complications whatsoever. The average hospital stay was 10.2 days. Left ventricular cavity size, measured (echocardiography) showed significant reduction 1 week postoperatively, which was unchanged after 1 month. The left ventricular ejection fraction was significantly increased 1 month postoperatively. After follow-up, on average 20 months, there was significant improvement in mean NYHA class. The modified Jatene correction of left ventricular aneurysm is simple, carries acceptable mortality and low morbidity and significantly improves left ventricular function.
心肌梗死后的左心室室壁瘤（LVA）具有较高的发病率和死亡率，而适当的外科治疗可能会降低这种情况。Jatene矫正术是一种有吸引力的室壁瘤修复技术。1986年7月至1995年5月期间，我们对72例患者采用了改良的Jatene矫正术。其中男性57例，女性15例，平均年龄61.6±8.2岁。15例患者（21%）出现恶性复发性室性心律失常。14例患者接受了急诊手术，3例为再次冠状动脉旁路移植术。58例患者（83%）处于纽约心脏协会（NYHA）心功能Ⅲ级和Ⅳ级。52例患者存在三支血管病变。术前左心室射血分数（LVEF）为30.4±12.2%（10 - 59%），左心室舒张末期压力为26.2±10.1 mmHg（12 - 41 mmHg）。围手术期总体死亡率为11.1%，1例患者发生围手术期心肌梗死。术后即刻，17例患者心输出量低，8例需要主动脉内球囊反搏。没有出血问题，30例患者（42%）术后无任何并发症。平均住院时间为10.2天。通过超声心动图测量，左心室腔大小在术后1周显著减小，1个月后保持不变。术后1个月左心室射血分数显著增加。随访平均20个月后，NYHA心功能分级平均有显著改善。改良的Jatene左心室室壁瘤矫正术操作简单，死亡率可接受且发病率低，并能显著改善左心室功能。
