急性心肌梗死后室间隔穿孔患者的外科治疗

Surgical Treatment of Ventricular Septai Rupture after Acute Myocardial Infarction

目的:探讨急性心肌梗死(AMI)后室间隔穿孔(VSR)的外科治疗方法和结果。方法:回顾分析手术治疗的8例急性心肌梗死后室间隔穿孔患者的临床资料。男性7例,女性1例,年龄62～74岁,平均年龄67．5岁,均有急性心肌梗死史,4例有高血压病史,2例有糖尿病史,6例合并室壁瘤。心功能NYHAⅢ级6例,Ⅳ级2例。术前射血分数(EF)值33％～71％,平均54．5％。患者心肌梗死至手术的间隔时间平均为5．4周。所有患者均采用牛心包补片旷置室间隔穿孔,7例患者同期行冠状动脉旁路移植术,平均2．7支／例。结果:手术死亡2例,死亡率25％。其中1例因多脏器功能衰竭于术后32 d死亡,另1例因肾功能不全于术后6 d死亡。存活6例随访3～24个月,平均13．2个月,无晚期死亡,无心血管事件。心功能NYHAⅠ级5例,Ⅱ级1例。术后EF值50％～66％,平均58．3％。结论:掌握适当的手术时机、完善的术前准备、积极的围手术期治疗、准确的手术操作和避免术后并发症的发生,能有效地降低急性心肌梗死后室间隔穿孔患者的死亡率,改善其预后。

Objective：To summarize the surgical indication, methods, and results in patients with ventricular septal rupture （VSR） after acute myocardial infarction （AMI）. Methods：From January 2003 to May 2006, eight patients with ventricular septal rupture after acute myocardial infarction were undertaken surgical repair. There were 7 males and 1 female with the mean age of 67.5 （62-74）years old. All patients had history of AMI,4 with hypertension,2 with diabetes mellitus, and 6 with ventricular aneurysm. Six patients＇ heart function was in NYHA Ⅲ ,2 patients in NYHA Ⅳ. The mean preoperative ejection fraction（EF） was 54.5%. The mean interval between AMI onset and surgery was 5.4 weeks. The technique of VSR exclusion with bovine pericardial patch was applied in all cases. Seven patients had concomitant coronary artery bypass grafting with mean graft 2.4 per patient. Results：The hospital mortality was 25% （2/8）. One patient died of multi-organ dysfunction 32 days after operation. The other patient died of renal failure 6 days after operation. Six patients survived after operation. There was no late death and cardiac events after 3-24 months follow-up （mean 13.2 months）. Five patients heart function was classified as Ⅰ , 1 patient as Ⅱ. The mean postoperative EF was 58.3 %. Conclusion： Proper surgical decision making, appropriate peri-operative management, and right surgical technique can salvage most patients with VSR after AMI.