左室内补片心室成型治疗心脏室壁瘤——附88例临床分析  

Left ventricular reconstruction with internal patch for patient with huge left ventricular aneurysm——Clinical report of 88 cases

作　　者：陈鑫[1] 徐明[1] 陈振强[1] 蒋英硕[1] 邱志兵[1] 肖立琼[1] 赵阳[1] 高岩[1] 缪劲[1] 郭子黄[1] 

机构地区：[1]南京医科大学附属南京第一医院心胸血管外科,266071

出　　处：《介入放射学杂志》2004年第S2期157-160,共4页Journal of Interventional Radiology

摘　　要：目的　回顾分析 88例左室内补片心室成型治疗巨大室壁瘤的临床经验和手术效果。方法　 88例患者中男 72例 ,女 16例 ,年龄 5 3～ 77(平均 6 6 )岁。手术前 74例有心绞痛 ;88例均有明确心肌梗死史 ,2 3例有多次心肌梗死史。冠状动脉造影示梗阻性病变在左主干 (LM) 2 2例次、左前降支 (LAD)88例次、对角支 5 5例次、回旋支 4 8例次、右冠状动脉 30例次。左室射血分数 (LVEF) 35 %± 17% (18%～5 4 % ) ,其中 >4 5 % 35例 ,4 5 %～ 30 % 36例 ,<30 % 17例。除 4例室壁瘤位于心脏下壁外 (下壁心肌梗死所致 ) ,其余 84例室壁瘤均位于心脏前壁和心尖 ,为前壁大面积梗死所致。同时伴需手术矫正的瓣膜功能不全 2 8例。 88例患者均在全身麻醉、体外循环 (CPB)下进行。切开室壁瘤后取净腔内血栓 ;采用 2 0Prolene线 ,将一合适大小的椭圆型补片缝闭室壁瘤的颈部即内口 ,将室壁瘤隔离 ,同时环缩室壁瘤内口 (内荷包 )的作用。特别注意将室间隔的大面积梗死区隔离到补片外 ,剪去外侧部分瘤体 ,连续缝合关闭心室切口 ,完成心内补片左室重建。 87例同时冠状动脉旁路手术 (人均旁路 1.87支 ) ;同期心脏瓣膜手术 2 8例。结果　 88例均顺利度过手术。平均主动脉阻断时间 6 8’ ,CPB10 3’。 16例患者需主动脉内球囊反搏Objective Retrospectively review the clinical experience of consecutive 88 patients who had Left Ventricular reconstruction with internal patch for huge left ventricular aneurysm.Methods There are 88 cases in this group ( male 72, female 16) with average age of 65.7 (53-77) years. All patients had history of myocardial infarction(MI) and 74 cases still had angina before surgery. 23 cases had more than one episode of MI. Cardiac catheterization showed significant coronary stenosis in left main in 22 cases, in LAD in 88 cases, in diagnol branch in 55 in cases, in circumference artery in 48 case、in right coronary artery in 30 cases. Left ventricular ejection friction ( LVEF)35±17%(18～54%),with 35 cases more than >45%,36 cases in between 45% and 30%,and 17 cases less than 30%. All the ameurysms were located in the anterior wall because of a big anterior wall MI except four cases whose aneurysms were in posterior wall because of inferior wall MI. All had surgery under cardiopulmonary bypass. After the LV aneyrysm was opened. All the mural thrombosis were removed and a decron patch of suitable size was put at the internal orifile between the aneurysm and normal myocardiam by 2-0 prolene surture to decrease the diameter of the orifile, to isolate the aneurysm ( include the infracted septal area ) , and to exclude all the rough internal surface with mural thrombosis. All but one had coronary artery bypass grafting at the same time. 28 patients had valve procedure simultaniosly for heart valve dysfunction. Results All patients went through the surgery with average CPB time of 103 mins, and aortic cross clamp time of 68 mins. 16 patients needed intro-aortic balloon pump (IABP) support for low EF. 77 cases were extubated within 24 hours post-operatively. 2 cases were re-explored for bleeding. 2 cases had stroke post-operatively with one full recovery. Sternal infection in 1 had sternal re-wired. There were two deaths in the group ( one from LCOS 7 days post-op, and another from MOF 11 days post-op) with mortali

关 键 词：心脏室壁瘤 心室成形 

分 类 号：R732.1[医药卫生—肿瘤]