Brazão A, de Oliveira F, Eugénio L, Antunes M
Cirurgia Cardiotorácica, Hospitais da Universidade de Coimbra.
Rev Port Cardiol. 1997 Feb;16(2):149-54, 124.
From May 1988 through October 1994, 44 patients with ischemic left ventricular aneurysm were operated upon. The mean age was 60.5 +/- 7.7 years and 36 patients (81.8%) were male. Thirty-two patients (72.7%) had congestive heart failure in NYHA class II or greater and 26 (59.1%) had moderate or severe left ventricular dysfunction. In 41 cases (93.2%) there was a history or electrocardiographic signs of myocardial infarction and only 3 patients (6.8%) were angina free. The location of the aneurysms was antero-apical or antero-lateral in 37 patients (84.1%) and inferior in 7 (15.9%), and intracavitary clot was present in 9 cases (20.5%). Fifteen patients (34.1%) were operated upon using standard linear repair, 8 (18.2%) by Stoney's technique and in the remaining 21 (47.7%) an endoventricular patch plasty was performed. All patients but one had CABG with a mean of 2.7 grafts per patient. The IMA was used in all patients with graftable LA disease (90.0%). Double IMA grafting was used in 10 patients (22.7%). Three patients (6.8%) had associated valvular surgery. Hospital mortality was 2.3% (1 patient) and morbidity 22.7% (10 patients); intra-aortic balloon counterpulsation was required in two patients. The mean time of hospitalization was 13.5 +/- 9.0 days. In the follow-up period (mean 29.2 +/- 21.5 months), 6 patients had required hospitalization (left ventricular failure -4; supraventricular arrhythmia-2) and two died. The remaining 32 survivors (78.0%) are in functional class I of the NYHA, without angina. Surgery of left ventricular ischaemic aneurysm was possible with low mortality and morbidity, with good functional results.
从1988年5月至1994年10月，对44例缺血性左心室室壁瘤患者进行了手术。平均年龄为60.5±7.7岁，36例（81.8%）为男性。32例（72.7%）患者有纽约心脏协会（NYHA）II级或更高级别的充血性心力衰竭，26例（59.1%）有中度或重度左心室功能障碍。41例（93.2%）有心肌梗死病史或心电图表现，仅3例（6.8%）无胸痛症状。37例（84.1%）室壁瘤位于心尖前或前外侧，7例（15.9%）位于下壁，9例（20.5%）有心腔内血栓形成。15例（34.1%）采用标准线性修复手术，8例（18.2%）采用斯通尼技术，其余21例（%）行心室内补片成形术。除1例患者外，所有患者均接受冠状动脉旁路移植术（CABG），平均每位患者移植2.7支血管。所有可移植左侧内乳动脉（IMA）的患者均使用了IMA（90.0%）。10例（22.7%）患者采用双侧IMA移植。3例（6.8%）患者同时进行了瓣膜手术。医院死亡率为2.3%（1例患者），发病率为22.7%（10例患者）；2例患者需要主动脉内球囊反搏。平均住院时间为13.5±9.0天。在随访期（平均29.2±21.5个月），6例患者需要住院治疗（左心室衰竭4例；室上性心律失常2例），2例患者死亡。其余32例幸存者（78.0%）纽约心脏协会心功能分级为I级，无胸痛症状。缺血性左心室室壁瘤手术死亡率和发病率较低，功能效果良好。
