术中经食管超声发现急性心肌梗死后室间隔穿孔合并室壁瘤一例  

The use of intraoperative transesophageal ultrasound in the assessment of ventricular septal rupture complicated with left ventricular aneurysm after acute myocardial infarction:A case report

作　　者：马俊[1] 宋海波[1] 郭应强[2] 李诗月 李茜[1] MA Jun;SONG Haibo;GUO Yingqiang;LI Shiyue;LI Qian(Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Cardiovascular Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China;Department of Anesthesiology,West China Hospital of Stomatology,Sichuan University,Chengdu,610041,P.R.China)

机构地区：[1]四川大学华西医院麻醉科,成都610041 [2]四川大学华西医院心血管外科,成都610041 [3]四川大学华西口腔医院麻醉科,成都610041

出　　处：《中国胸心血管外科临床杂志》2022年第6期797-800,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81873500)。

摘　　要：本文报道1例65岁女性患者,因“反复剑突下疼痛伴呼吸困难10+d”就诊。心电图检查提示:急性广泛前壁ST段抬高型心肌梗死;术前经胸超声心动图提示室间隔穿孔。拟行体外循环下室间隔穿孔修补术。术中经食管超声心动图检查发现左心室室壁瘤形成,协助外科医生确认左心室切口入路,改善了患者预后。手术时间197 min,术中主动脉阻断时间56 min,体外循环时间69 min,术后安全返回ICU。患者术后第1 d拔除气管插管,第2 d撤除主动脉内球囊反搏辅助装置。出院前心脏超声结果显示:室间隔穿孔修补、室壁瘤切除术后;室水平未见明显残余分流。患者于术后第12 d好转出院,随访至术后6个月,患者精神状况可,日常生活不受限制。We reported a 65-year-old female who was admitted to our institute with"recurrent subxiphoid pain accompanied by dyspnea for more than 10 days".Electrocardiogram examination suggested acute extensive anterior ST segment elevation myocardial infarction.Preoperative transthoracic echocardiography suggested ventricular septal rupture.The patient was planned for the repair of ventricular septal rupture with cardiopulmonary bypass.The formation of left ventricular aneurysm was diagnosed by intraoperative transesophageal echocardiography(TEE).The surgeon decided to abdopt the modified incision of left ventricular approach guided by TEE,which greatly improved the prognosis of the patient.The surgery duration was 197 min,aortic cross-clamping time was 56 min,cardiopulmonary bypass time was 69 min,and the patient was safely admitted to ICU after the surgery.Extubation was performed on the first day postoperatively,and the intra-aortic balloon pump support was retreated on the second day postoperatively.Postoperative echocardiography showed that no obvious residual shunt was observed after ventricular septal repairment and ventricular aneurysm resection.The patient was discharged on the 12th day after the surgery.Additionally,the mental condition was good and daily activities were not limited within 6 months postoperatively.

关 键 词：急性心肌梗死 室间隔穿孔 室壁瘤 经食管超声心动图 病例报告 

分 类 号：R654.2[医药卫生—外科学]