非体外循环下左心室重建联合冠状动脉旁路移植术治疗左心室室壁瘤

Off-pump left ventricular reconstruction and coronary artery bypass grafting for left ventricular aneurysm

目的评价在非体外循环下行左心室重建术+冠状动脉旁路移植术治疗左心室室壁瘤的效果。方法左心室室壁瘤患者103例,在非体外循环下先行冠状动脉旁路移植术,其中乳内动脉与前降支吻合80例,大隐静脉-前降支或其他血管吻合21例,2例未搭桥,然后用2-0聚丙烯线围绕前间壁及心尖部室壁瘤基底部全层荷包缝合室壁瘤及室壁瘤的游离壁以消除死腔。结果术后发生低心排综合征10例,脑卒中2例,开胸止血2例,室性心律失常3例,死亡3例;手术前左心室舒张末内径(66.59±9.76)mm,术后减少到(50.00±5.30)mm(P<0.05);左心室舒张末容积由术前(165.20±59.48)mL减少到(85.60±23.70)mL(P<0.05);左心室射血分数由术前(35.70±0.05)%增加到(50.00±0.04)%(P<0.05)。结论非体外循环左心室重建术+冠状动脉旁路移植术治疗左心室室壁瘤手术操作简单,并发症少,近期疗效良好。

Objective To study the effect of off-pump left ventricular reconstruction plus coronary artery bypass grafting on left ventricular aneurysm.Methods A total of 103 patients with left ventricular aneurysm received off-pump coronary artery bypass grafting,in which left internal mammary artery was anastomosed to left anterior descending in 80 cases,saphonous was anastomosed to left anterior descending or other stenosis vessels in 21 cases,and 2 cases were not performed bypass surgery.2-0 Prolene was used to do a circular purse-string suture along the left ventricular aneurysm border zone into the scarred tissue after coronary artery bypass grafting was finished,left ventricular aneurysm was reinforced with continuous suture in order to diminish dead chamber,and the left ventricle was restored nearly to its normal chamber.Results Low cardiac output syndrome occurred in 10 cases,stroke in 2 cases,bleeding in 2 cases,ventricular arrhythmia in 3 cases,and 3 cases died.Left ventricular end-diastolic dimension decreased to（50.00±5.30） mm after operation from（66.59±9.76） mm before opration（P0.05）,left ventricular end-diastolic volume decreased to（85.60±23.70） mL after operation from（165.20±59.48） mL before operation（P0.05）,and left ventricular ejection fraction increased to（50.00±0.04）% after operation from（35.70±0.05）% before operation（P0.05）.Conclusion Off-pump left ventricular reconstruction plus coronary artery bypass grafting is easy and simple with less complications and good short-term results for left ventricular aneurysm.