冠心病并发左室室壁瘤的心室壁重建  

LEFT VENTRICULAR RECONSTRUCTION IN PATIENTS WITH LEFT VENTRICULAR ANEURYSM AFTER MYOCARDIAL INFARCTION

作　　者：王强[1] 徐莉[2] 王东进[1] 

机构地区：[1]南京大学医学院附属鼓楼医院心胸外科,南京210008 [2]南京大学医学院附属鼓楼医院药剂科,南京210008

出　　处：《中国修复重建外科杂志》2011年第8期998-1000,共3页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家自然科学基金资助项目(81070241)~~

摘　　要：目的探讨冠心病患者心肌梗死后并发左室室壁瘤的心室壁重建方法及疗效。方法 2003年6月-2008年8月,收治冠心病心肌梗死后并发左室室壁瘤患者23例。其中男13例,女10例;年龄47～74岁,平均61.2岁。心功能根据纽约心脏病协会(NYHA)分级标准:Ⅰ级3例,Ⅱ级6例,Ⅲ级10例,Ⅳ级4例。冠状动脉造影示冠状动脉单支病变2例,2支5例,3支16例。部位:心尖部18例,前壁合并外侧壁4例,单纯下壁1例。左室射血分数为36.52%±12.15%,左室舒张期末内径为(62.30±6.52)mm。术中直接行标准线性修补术9例,心内膜环缩后线性修补术6例,心内膜环缩后补片修补术8例。结果围手术期死亡2例,二次开胸止血1例;其余患者切口均Ⅰ期愈合,无早期相关并发症发生。术后21例存活患者均获随访,随访时间7～48个月,中位随访时间19个月。术后6个月,患者左室射血分数为46.52%±9.41%,较术前明显改善(t=2.240,P=0.023);左室舒张期末内径为(52.23±5.11)mm,较术前显著减小(t=2.170,P=0.035)。6个月时患者心功能根据NYHA分级标准:Ⅰ级8例,Ⅱ级13例。1例患者于术后18个月因脑出血死亡,其余患者均恢复日常生活。结论对冠心病并发左室室壁瘤患者,应根据不同病情采取个体化治疗,选择合适的瘤切除及心室壁重建方法,同期处理合并二尖瓣关闭不全和行冠状动脉旁路移植术,可取得良好效果。Objective To discuss left ventricular reconstruction methods and effectivness in patients with left ventricular aneurysm after myocardial infarction. Methods Between June 2003 and August 2008, 23 patients with left ventricular aneurysm after myocardial infarction were treated. Of them, 13 were male and 10 were female with an average age of 61.2 years （range, 47-74 years）. According to New York Heart Association （NYHA） criteria for cardiac function, there were 3 cases of grade Ⅰ, 6 cases of grade Ⅱ, 10 cases of grade Ⅲ, and 4 cases of grade Ⅳ. The coronary arteriongraphy showed single-vessel disease in 2 cases, double-vessel disease in 5 cases, triple-vessel disease in 16 cases. The locations of ventricular aneurysm were the apex cordis in 18 cases, antetheca and parieslateralis in 4 cases, and interior wall in 1 case. The left ventricular ejection fraction was 36.52%±12.15%, and left ventricular diastolic final diameter was （62.30±6.52 ） mm. Nine patients received standard linear repair, 6 patients received standard linear repair after endocardial ring shrinkage, and 8 patients received patch suture after endocardial ring shinkage. Results Two cases died perioperatively, and re-thoracotomy was performed to stop bleeding in 1 case. Incisions healed by first intention in the other patients without early complication. Twenty-one patients were followed up 7-48 months （median, 19 months）. At 6 months after surgery, the left ventricular ejection fraction 46.52%±9.41% were significanly improved when compared with that at preoperation （t=2.240, P=0.023）; the left ventricular diastolic final diameter （52.23±5.11） mm were significantly decreased when compared with that at preoperation （t=2.170, P=0.035）. The cardiac function according to NYHA criteria was at grade Ⅰ in 8 cases and at grade Ⅱ in 13 cases. One patient died of cerebral hemorrhage at 18 months after operation and the activities of daily living recoverd in the others. Conclusion Individual theraputic methods are used

关 键 词：冠心病 心肌梗死 室壁瘤 心室壁重建 

分 类 号：R542.22[医药卫生—心血管疾病]