Sakai K, Takami H, Fukuda H, Ohnishi K
Division of Cardiovascular Surgery, Yao Takusyukai General Hospital, Osaka, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Jul;45(7):940-4.
From 1980 to 1995, we experienced 20 cases of surgical repair for left ventricular free wall rupture complicating acute myocardial infarction. These were divided into three types based on their clinical symptoms; 10 of the sudden blowout type, 4 of the rapid blowout type and 6 of the oozing type. In the rapid type, unconsciousness following the onset of the blowout rupture was restored by cardiopulmonary resuscitation (CPR) or pericardiocentesis. Seven out 20 cases (35%) survived. In the sudden blowout type, only one case treated by using the pericardial patch gluing technique without cardiopulmonary bypass survived. Three out of 4 cases (75%) of the rapid blow out type survived. Three out 6 cases (50%) of the oozing type survived. The causes of death were classified as table death for 5 cases, LOS for 1 case, and cerebral death for 3 cases of the 9 fatal cases of the sudden blowout type. Hemostasis was very difficult in 1 case of the rapid type. The 3 cases of the oozing type died respectively of LOS, cerebral death and pneumonia after surgery. Pericardiocentesis or subxyphoid drainage was performed preceding the repair of the rupture in 4 cases of the rapid blowout, and in 5 cases of the oozing type. However, re-rupture occurred in 2 cases of the rapid type and in 2 cases of the oozing type. In 7 cases in whom pericardial patch gluing technique was applied, a procedure in use since 1990, all cases were safely weaned from CPB, with 4 cases out of 7 (57%) surviving. Meanwhile, in 13 cases in which infarctectomy and myocardiography was carried out, 5 cases (38%) could not be weaned from CPB. Three cases (23%) survived after infarctectomy and myocardiography. Even some cases of blowout rupture were able to survive as long as blood pressure was elevated and consciousness was restored by CPR or pericardiocentesis as in cases of the rapid type. The pericardial patch gluing technique at the infarct site proved to be an effective procedure.
1980年至1995年期间，我们共经历了20例因急性心肌梗死并发左心室游离壁破裂而进行手术修复的病例。根据临床症状，这些病例分为三种类型：突发破裂型10例，快速破裂型4例，渗血型6例。在快速破裂型中，破裂发作后出现的昏迷通过心肺复苏（CPR）或心包穿刺得以恢复。20例中有7例（35%）存活。在突发破裂型中，仅1例采用心包补片粘贴技术且未进行体外循环的病例存活。快速破裂型中的4例中有3例（75%）存活。渗血型中的6例中有3例（50%）存活。9例突发破裂型死亡病例的死亡原因分类为术中死亡5例，术后住院期间死亡1例，脑死亡3例。快速破裂型中有1例止血非常困难。渗血型的3例分别死于术后住院期间死亡、脑死亡和肺炎。4例快速破裂型和5例渗血型在破裂修复前进行了心包穿刺或剑突下引流。然而，快速破裂型中有2例和渗血型中有2例发生了再破裂。在1990年起使用的7例应用心包补片粘贴技术的病例中，所有病例均安全脱离体外循环，7例中有4例（57%）存活。同时，在13例进行梗死灶切除术和心肌造影术的病例中，5例（38%）无法脱离体外循环。梗死灶切除术和心肌造影术后有3例（23%）存活。即使是一些破裂型病例，只要能像快速破裂型病例那样通过CPR或心包穿刺使血压升高并恢复意识，也能够存活。梗死部位的心包补片粘贴技术被证明是一种有效的手术方法。
