6例室间隔夹层瘤的诊断治疗和随访分析  

Diagnosis,treatment and follow-up analysis of 6 cases of dissecting aneurysm of the interventricular septum

作　　者：李好友 王敏[2] 张文峰 吴建涛[1] 王天毅 生伟[1] 牛兆倬[1] Li Haoyou;Wang Min;Zhang Wenfeng;Wu Jiantao;Wang Tianyi;Sheng Wei;Niu Zhaozhuo(Department of Cardiovascular Surgery,Qingdao Municipal Hospital,Qingdao 266071,China;Department of Clinical Laboratory,the Ninth People’s Hospital of Qingdao,Qingdao 266002,China)

机构地区：[1]青岛市市立医院心脏外科,266071 [2]青岛市市立医院西院区(青岛市第九人民医院)检验科,266002

出　　处：《中国心血管杂志》2021年第5期463-467,共5页Chinese Journal of Cardiovascular Medicine

基　　金：青岛市2018年度医药科研指导计划(2018-WJZD009)。

摘　　要：目的探讨室间隔夹层瘤(DAIS)的诊断与治疗方法,提高临床医生对其认识,改善患者预后。方法回顾性分析2006年5月至2018年1月青岛市市立医院心脏外科收治的6例DAIS患者的临床资料和随访情况。结果6例DAIS患者中,3例与主动脉窦瘤破裂有关,其中1例以左束支传导阻滞初次就诊时漏诊,因胸闷、憋气再次入院后明确诊断;2例由感染性心内膜炎引起;1例为急性心肌梗死所致,术前误诊为室间隔穿孔,于急症手术探查过程中明确诊断。所有患者均在全麻体外循环下行DAIS修补术。感染性心内膜炎和主动脉窦瘤破裂所致DAIS的5例患者手术效果满意,其中1例感染性心内膜炎患者术后当天出现Ⅲ度房室传导阻滞,急诊植入临时起搏器。急性心肌梗死并发DAIS的患者术后出现顽固性低心排血量,术后7 d死于多脏器功能衰竭。其他5例患者术后随访2~12年均存活,NYHA心功能分级Ⅰ~Ⅲ级。结论感染性心内膜炎和主动脉窦瘤破裂是DAIS的主要原因,手术效果确切。Objective To explore the diagnosis and treatment of the dissecting aneurysm of the interventricular septum(DAIS),to improve clinicians’understanding of this disease and patient prognosis.Methods Six patients diagnosed with DAIS in Department of Cardiovascular Surgery,Qingdao Municipal Hospital from May 2006 to January 2018 were enrolled.All the patients underwent surgery.The clinical data and follow-up data were collected.Results Of the six DAIS patients,three were associated with sinus of Valsalva(SOV).One patient was missed to diagnose when he first presented with left bundle branch block caused by the right SOV ruptured into interventricular septum.Two patients had DAIS because of infective endocarditis.One DAIS patient complicated with acute myocardial infarction(AMI),and missed diagnosis with interventricular septal rupture.All patients were confirmed by cardiac surgery facilitated with cardiopulmonary bypass under general anesthesia.Surgical results were satisfactory in DAIS patients with infective endocarditis and ruptured SOV.One patient with infective endocarditis had a temporary pacemaker implanted because of developedⅢdegree atrial-ventricular block on the day after surgery.The AMI patient developed persistent low cardiac output and finally died of multiorgan failure on the 7 th day after surgery.The other 5 patients were followed up 2-12 years and all alive.NYHA classification wasⅠ-Ⅲgrade.Conclusions Infective endocarditis and rupture of aortic sinus aneurysm are the main causes of DAIS.The surgical effect is definite.

关 键 词：室间隔夹层瘤 外科手术 主动脉窦瘤破裂 

分 类 号：R654.2[医药卫生—外科学]