冠状动脉旁路移植术及室壁瘤切除术

Coronary Artery Bypass Grafting and Ventricular Aneurysmectomy

本文报道冠状动脉旁路移植术和室壁瘤切除术５１例。全组中３４例为不稳定心绞痛，２５例多支病变，５例左主干狭窄，２４例陈旧性心肌梗死，１０例合并高血压，左室射血分数０．１４～０．７９，小于０．３者６例。均在常规体外循环和心脏停搏下手术，共架血管桥１０１支。全组１０例同期作了室壁瘤切除术，后者还同时修补室间隔穿孔和间隔瘤各１例。附加手术有心脏瓣膜替换术，冠状动脉内膜切除术和激光心肌再血管化各４例，术中冠脉腔内成形术２例及三尖瓣成形术１例。手术死亡７例，均与术前高危因素及左室功能差有关。随访６～１０８个月，３１例心绞痛消失，４例偶有轻度心绞痛，７例仍有劳力性心绞痛；晚期死亡２例，分别死于重症乙型肝炎和心律失常。重点讨论了手术病例选择，冠状动脉内膜切除术，室壁瘤切除修复术以及架桥与换瓣同期手术问题。

patients (PTS) underwent coronary artery bypass grafting (CABG) and left ventricular aneurysm resection(VAR), 43 males and 8 fomales. Age ranged from 39 to 68 years. Most of PTS had high risk factors, unstable angina (34) ,previous myocardial infarction (24) , multi-vessel diseases (25) , left main trunk lesion ( 5 ) and associated hypertension (10) .LVEF ranged from 0.14 to 0.79 (Lessthan 0.30 in 6 cases) .The operations were performed under CPB with cardiac arrest. The total number or vessel grafts wore 101. 10 PTS had VAR.C AB G with VAR plus VSD repair or septal aneurysmectomy for 1 case respectively. In addition, valve replacements, endarterectomy and laser transmyocardial revascularization were simultaneously performed m 4 cases respectively, OTCA in 2 cases and TVP in 1 case.7 PTS died, the cauces of death were related to the preoperative risk factors and poor LV function. Following-up 6 to 108 months, 31 PTS wore free of angina,4 had mild angina and 7 had effort angina.There was two late death. because of severe serum hepatitis and cardiac arrhythmia respectively.The patient selection for operation, corconary artery endarterectomy, ventricular aneurysm resection and valve replacement with C A B G are discussed.