121例心肌梗塞左心室乳头肌的病理分析

PATHOLOGICAL ANALYSIS OF PAPILLARY MUSCLE IN THE LEFT VENTRICLE OF CORONARY HEART DISEASE(121 AUTOPSIED CASES)

本文对１２８例冠心病左心室乳头肌的病变，结合临床进行了分析和讨论。其中左心室乳头肌查见不同程度的心肌梗塞１２１例（９４．５％）、冠状动脉多支粥样硬化Ⅳ级狭窄９８例（７６．５％）；９８例中乳头肌查见单一急性心肌梗塞（ＡＭＩ）２１例（２１．４％）、ＡＭＩ＋陈旧性心肌梗塞（ＯＭＩ）６４例（６５．３％）、单一ＯＭＩ１３例（１３．３％）。这显示冠状动脉粥样硬化多支Ⅳ级狭窄中乳头肌绝大多数有陈旧性合并ＡＭＩ。冠状动脉主干在粥样硬化狭窄的基础上并发血栓形成常导致乳头肌ＡＭＩ。本组２３例心脏破裂患者中有２０例在乳头肌查见有急性贯通性心肌梗塞。２５例左心室室壁瘤中左心室乳头肌查见ＯＭＩ＋ＡＭＩ１６例（６４％）占大多数。本文对左心室乳头肌病变与二尖瓣功能损伤的关系也进行了讨论。

The lesions in papillary muscle of the left ventricle have important influence on the cardiovascular function. This paper is aimed to study the relationship between the lesions and the degree of coronary atherosclerotic stenosis, coronary thrombosis,myocardial infarction so as to provide some clues for the treatment and prevention of coronary heart disease(CHD).121 cases with various degrees of myocardial infarction were found in 128 cases of CHD (94.4%).Multiple branches of the coronary arteries with grade IV AS stenosis were found in 98 cases (76.6%).Among the 98 cases,the papillary muscle of left ventricle showed single AMI in 21 cases (21.4%),AMI+OMI 64 cases (65.3%),single OMI 13 cases (13. 3%). Therefore,grade IV AS stenosis is a common cause of myocardial infarction in the papillary muscle of left ventricle.Acute myocardial infarction and rupture of papillary muscle in the left ventricle were closely related to thrombosis in the main branches of coronary arteries.23 cases of cardiac rupture were found in this series, in which 20 cases showed AMI (87%) in papillary muscle of the left ventricle.25 cases were found to have left ventricular aneurysm in which 7 cases showed single OMI(28%),16 cases OMI complicated with AMI(64%),2 cases single AMI (8%).This results suggest that OMI is present in papillary muscle of the left ventricle in most cases of ventricular aneurysm. The relationship between the lesions of papillary muscle of left ventricle and mitral function was also discussed.