心肌梗死后室间隔穿孔的外科治疗

Surgical treatment of postinfarction ventricular septal defect

目的总结心肌梗死(心梗)后室间隔穿孔的外科治疗方法。方法自1990年至2004年,外科治疗22例心梗后室间隔穿孔病人,其中前室间隔穿孔19例,后室间隔穿孔3例;合并室壁瘤18例。结果全组手术死亡8例,其中1999年前13例中死亡7例,1999年后9例中仅死亡1例。余者症状消失,治愈出院。出院时心功能均为I^II级。结论心梗后室间隔穿孔是少见而严重的并发症,手术为最佳治疗方法。术前应行冠状动脉造影,如有狭窄,术中应充分进行冠状动脉再血管化。

Objective To review our experience of surgical treatment for postinfarction ventricular septal defect. Methods From 1990 to 2004, 22 patients with postinfarction ventricular septal defect underwent surgical treatment, There were 15 males and 7 females with a mean age of （62.2 ± 7.3） years （from 52 years to 72 years）, 19 had anterior ventricular septal defect and 3 had posterior VSD, and there were 18 cases with left ventricular aneurysm. 10 patients also had intreaortic balloon pumping in the early experience. In all the patients cardiac function were in NYHA class Ⅲ -Ⅳ. Results There were 8 operative deaths （35 % ）, There were 7 operative deaths before 1999 and 1 case after 1999. The other patients are clinically asymptomatic after surgery, and the cardiac function is in NYHA class Ⅰ-Ⅱ . Conclusion Postinfarction ventricular septal defect is an infrequent but serious complication of myocardial infarction. Surgery is the best way to treat this condition. A coronary angiography should be performed in all patients who can be stabilized hemodynamically and myocardial revascularization should be performed in patients with significant coronary artery stenesis.