16例先天性左心室室壁瘤或憩室患者的临床特征及长期随访结果  

Clinical characteristics and long-term follow-up of 16 patients with congenital left ventricular aneurysms or diverticula

作　　者：杨稳 董艳 陈铳铳 周秀娟 单其俊 YANG Wen;DONG Yan;CHEN Chong-chong;ZHOU Xiu-juan;SHAN Qi-jun(Department of Cardiology,the First,Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学第一附属医院心血管内科,江苏省南京市210000

出　　处：《中国心血管病研究》2022年第2期143-147,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的观察并分析先天性左心室室壁瘤或憩室患者的临床特征及预后。方法回顾性分析南京医科大学第一附属医院心血管内科自2004年1月至2020年12月明确诊断为先天性左心室室壁瘤或憩室的患者16例,随访(58.00±34.16)个月,观察终点为主要不良事件发生率及预后情况,主要不良事件包括恶性室性心律失常、心力衰竭和血栓栓塞。结果患者发病年龄为(55.00±16.64)岁,男性较多,占68.75%。4例患者合并心力衰竭,11例患者合并恶性室性心律失常,1例患者合并血栓栓塞。患者室壁瘤或憩室最常见于心尖部和后基底部,各占37.5%。16例患者中14例发生主要不良事件,整体发生率为75.00%。其中,恶性室性心律失常的发生率最高,为68.75%,心力衰竭次之,为25.00%,血栓栓塞最低,为6.25%。药物和射频消融治疗在室性心律失常的管理上有一定价值,但随访时发现40.00%接受射频消融治疗的患者复发。药物治疗在此类患者的心力衰竭的管理上效果不佳。室壁瘤切除可有效预防血栓栓塞复发。结论先天性左心室室壁瘤或憩室致病率较低,但其致病时往往导致严重的心血管不良事件。因此不论是否合并并发症,均需要长期规范的随访。Objective To observe and analyze the clinical characteristics and prognosis of patients with congenital left ventricular aneurysm or diverticulum. Methods A retrospective analysis was performed on 16 patients with congenital left ventricular aneurysms or diverticula, from January 2004 to December 2020 in the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University. The patients were followed up for(58.00±34.16) months. The end-points were the incidence and prognosis of major adverse events, including malignant ventricular arrhythmias, heart failure and thromboembolism. Results The mean age of the patients was(55.00±16.64) years. 75.00% were male. Four patients were complicated with heart failure;eleven patients were complicated with malignant ventricular arrhythmia and one patient was complicated with thromboembolism. The apical and posterior bases of the heart were the most common areas of the left ventricular aneurysm or diverticula.75.00% of the patients experienced adverse events. Among them, the malignant ventricular arrhythmia was the highest, 68.75%, followed by heart failure, 25.00%, and thromboembolism, 6.25%. Drugs and radiofrequency ablation had certain value in the management of ventricular arrhythmias, while 40.00% of patients recurred after receiving radiofrequency ablation during the follow-up. Drug therapy was not effective in the management of heart failure in such patients. Resection of the ventricular aneurysm could effectively prevent the recurrence of thromboembolism. Conclusion The incidence of congenital left ventricular aneurysm or diverticulum is lower but it often leads to serious cardiovascular adverse events. Therefore, long-term and standardized follow-up is needed whether there are complications or not.

关 键 词：室壁瘤 憩室 室性心律失常 心力衰竭 血栓栓塞 

分 类 号：R714.5[医药卫生—妇产科学]