Kleiger R, Shaw R
Arch Intern Med. 1977 Nov;137(11):1580-6.
Papillary muscle rupture, ventricular septal defect, and ventricular aneurysm represent complications of myocardial infarction that require surgical intervention. Since operative mortality and morbidity are increased in proportion to the degree of myocardial and pulmonary disease, early diagnosis and surgical intervention is mandatory. Diagnostic procedures of choice include careful and serial ECG analysis and cardiac auscultation, especially in patients with postinfarction refractory angina or congestive heart failure; Swan-Ganz catheterization, echocardiography; and, in appropriate instances, ventricular and coronary angiography should also be performed preoperatively. With early identification of patients at risk of developing these complications, and careful preoperative hemodynamic studies, surgical repair should lead to improvement in myocardial function and more effective response to post-operative medications in patients previously resistant to such therapy.
乳头肌破裂、室间隔缺损和室壁瘤是心肌梗死需要手术干预的并发症。由于手术死亡率和发病率与心肌和肺部疾病的程度成正比增加，早期诊断和手术干预是必要的。首选的诊断方法包括仔细的系列心电图分析和心脏听诊，特别是在心肌梗死后难治性心绞痛或充血性心力衰竭患者中； Swan-Ganz导管插入术、超声心动图；并且在适当情况下，术前也应进行心室和冠状动脉造影。通过早期识别有发生这些并发症风险的患者，并进行仔细的术前血流动力学研究，手术修复应能改善心肌功能，并使先前对这种治疗有抵抗的患者对术后药物产生更有效的反应。
