室间隔折叠治疗左室前壁并前间隔巨大室壁瘤

Ventricular septal plication for post infarction anterior and anterior-septal aneurysm of the left ventricle

目的:评价室间隔折叠加Dor或Cooley术式治疗心肌梗死后左室前壁并前间隔巨大室壁瘤的效果。方法:23例心肌梗死后左室前壁并前间隔巨大室壁瘤采用室间隔折叠、前壁室壁瘤行Dor或标准线性缝合术,同期行冠状动脉搭桥术,对比患者术前、出院前、术后3个月的心功能NYHA分级、舒张末期容积指数(LVEDVI)、收缩末期容积指数(LVESVI),左室射血分数(LVEF)值。结果:与术前相比,出院前、术后3个月NYHA分级从3.21±0.62分别提高到1.72±0.31和1.57±0.23(P<0.05),LVEDVI从(102.31±18.71)mL/m2分别减少到(62.11±6.21)mL/m2和(54.63±4.54)mL/m2(P<0.05),LVESVI从(69.32±17.48)mL/m2分别减少到(30.23±3.25)mL/m2和(28.34±3.12)mL/m2,LVEF从(32.92±8.12)%分别提高到(48.78±4.51)%和(50.52±4.68)%(P<0.05)。结论:冠心病左室前壁并前间隔巨大室壁瘤室间隔采用折叠术、前壁室壁瘤行Dor或标准线性缝合术能明显改善左心室功能。

Objective： To determine the use of septal plication with Dor or Cooley procedure for post infarction anterior and anterior-septal aneurysm of the left ventricle. Methods： A total of 23 patients with post infarction anterior and anterior-septal aneurysm of the left ventricle underwent septal plication and Dor or Cooley procedure along with coronary artery bypass grafting concomitantly. Data of NYHA grading, left ventricular end diastolic volume index （LVEDVI）, left ventricular end systolic volume index （LVESVI） and left ventricular ejection fraction （LVEF） were recorded before the surgery,before discharge and 3 months after the surgery. Results： Compared with the preoperative data, the NYHA grading before the discharge and 3 months after the surgery improved from 3.21±0.62 to 1.72±0.31 and 1.57±0.23（P〈0.05）; LVEDVI decreased from （102.31±18.71） mL/m2 to （62.11±6.21） mL/m2 and （54.63_±4.54） mL/m2 （P〈0.05）; LVESVI decreased from （69.32±17.48） mL/m2 to （30.23±3.25）mL/m2 and （28.34±3.12） mE/mE; while LVEF increased from （32.92±8.12）% to （48.78±4.51）96 and（50.52±4.68）% （P〈0.05）, respectively. Conclusion： Ventricular septal plication combined with Dor or Cooley procedure can remarkably improve the left heart function in patients with post infarction ventricular aneurysm.