左心室部分切除术治疗终末期心力衰竭

Left ventricular volume reduction for the treatment of end stage dilated cardiomyopathy

目的 对终末期扩张型心肌病患者采用外科左心室部分切除术减小左心室容积 ,并观察缓解心力衰竭 (心衰 )的疗效。方法 4例患有进行性加重的充血性心衰患者的病因分别为原发性(2例 )、瓣膜性(1例 )和缺血性 (1例 )心肌病 ,所采用的术式包括“乳头肌间室壁切除”1例及“超乳头肌室壁切除”3例 (后者含二尖瓣替换)。同期手术还包括主动脉瓣替换 2例和冠状动脉搭桥 1例。结果 所有患者都顺利脱离体外循环 ,并在术后 (2 5± 2 )小时拔除气管插管。心输出量由术前 (2 0±0 2 )升 /min增至术后 (4 1±0 3 )升 /min(P =0 .0 0 1)。除 1例患者 3周后死于细菌性纵隔感染所致败血症外 ,另 3例平均 14天后出院。随访 (最多达 2 2个月 )证实这 3例患者均保持在纽约心脏协会心功能Ⅰ级。结论 左心室部分切除术为终末期扩张型心肌病患者缓解心衰症状 ,早期临床效果良好。

Objective To study the effect of partial left ventriculectomy(PLV) in the alleviation of heart failure for patients with end stage dilated cardiomyopathy. Methods Four patients (mean age 57 years) underwent PLV in our hospital. Preoperatively, all patients had advanced symptomatic congestive heart failure due to idiopathic ( n =2), valvular ( n =1), and ischemic cardiomyopathy ( n =1). Interpapillary ( n =1) or extrapa pillary ( n =3) types of PLV resection were performed, the latter necessitating mitral valve replacement in 3 patients. Associated procedures were aortic valve replacement ( n =2) and coronary artery bypass grafting ( n =1). Results All patients were successfully weaned from cardiopulmonary bypass, and were extubated 25±2 hours after surgery. Postoperative cardiac output increased from 2.0±0.2 to 4.1±0.3 L/min( P =0.001). One patient died 3 weeks after surgery of sepsis due to acute bacterial mediastinitis. Average hospital stay for the other three patients was 14 days. At a follow up up to 22 months, all three patients were in NYHA functional class I. Conclusion PLV is associated with early favorable clinical outcome in the alleviation of heart failure for patients with end stage dilated cardiomyopathy.