左心室假性室壁瘤77例文献回顾分析

Clinical and imaging profile of left ventricular pseudo-aneurysm： a review of 77 cases

目的分析中国内地左心室假性室壁瘤（LVPA）的临床特点与转归。方法检索万方数据库、中国知网全文数据库、中文科技期刊数据库及Pubmed数据库，分析1986年1月至2012年4月中国内地报道的LVPA患者的临床、影像、治疗和转归。结果检索到符合要求的文献65篇，报告患者77例，LVPA77个（5例与真性室壁瘤并存）。男性56例（72．7％），中位年龄48岁（5～82岁）。最常见的病因是心肌梗死（40／77，51．9％），常见症状是气短或呼吸困难（33／74，44．6％）、胸闷和胸痛（31／74，41．9％），10．8％的患者无症状。无合并血栓栓塞事件的报道。有相关检查资料者中，86．4％（38／44）的患者有心电图异常，91．4％（32／35）者有胸片异常。经胸超声心动图是最常用的检查，其诊断LVPA的准确性约85．7％（60／70）。77例中19例（24．7％）瘤体自发破裂，15例（19．5％）患者死亡，最常见的死因是心包填塞和猝死。结论LVPA少见、高危而又缺乏特异的临床表现，有冠心病或心力衰竭症状的患者应提高警惕避免漏诊，一旦发现应急诊手术。

Objective To review the clinical characteristics of left ventricular pseudo-aneurysm （LVPA） in China mainland. Methods The China National Knowledge Infrastructure （CNKI） , Wanfang Data, VIP information and PubMed database were searched to extract information on clinical profile, diagnostic imaging, treatment and outcome of patients with LVPA from January 1986 to April 2012. Results Clinical data of 77 patients with LVPAs （ including 5 coexistent with true aneurysm） were extracted from 65 articles. There were 56 males （72. 7% ） and 11 females （27. 3% ） with a median age of 48 years old（range 5 to 82 ）. The most common etiology was myocardial infarction （40, 51.9% ）. Breathlessness/dyspnea （44. 6% ）, chest discomfort （41.9%） and chest pain （41.9%） were the most frequently reported symptoms, but asymptomatic patients accounted for 10. 8% of all. 86. 4% of the patients had electrocardiographic abnormalities, most of which were nonspecific ST segment changes. No event of thromboembolism was reported. Transthoracic echocardiography was the most commonly used diagnostic imaging test, followed by angiography with which no complication was reported. 19 cases of pseudo-aneurysms （24. 7% ）were reported to rupture and 15 patients（ 19. 5% ）died, mostly of cardiac tamponade and sudden death. Conclusions LVPA is a rare and life-threatening disorder. It lacks of specific clinical manifestations distinguishable from coronary disease or heart failure. Emergency surgery is warranted once it is identified.