左室室壁瘤的手术治疗

Surgical management of left ventricular aneurysm

目的 完善左室室壁瘤的手术治疗。 方法 2 8例左室室壁瘤病人采用低温室颤左室引流、不阻断升主动脉的方法保护心肌 ,单纯室壁瘤心外折迭术 1例 ,室壁瘤切除后三明治缝合术 2 0例 ,心腔内成形术 7例。所有病例术中均行冠状动脉旁路术 ,人均搭桥 3.1± 1.2支。其中左室壁激光心肌再血管化 15例 ,人均打孔 2 9.8± 9.5个。术后使用主动脉内球囊反搏 7例。 结果 2 7例手术成功 ,手术死亡 1例 ,术后低心排 5例。出院后 2 1例心绞痛明显缓解 ,心功能平均提高 ～ 级。 结论 采用低温室颤左室引流和不阻断升主动脉的技术行室壁瘤切除手术有益于术后恢复 ,左室重建成形、冠状动脉旁路移植术和激光心肌再血管化并用是提高手术疗效的关键。

Objective The study is conducted to improve the surgical management of left ventricular aneurysm(LVA). Methods 28 patients with LVA were operated with the use of ventrical fibrillation left ventricular drainage with hgpothermia noncrossclamping the flow of ascending aorta to protect the muscles of heart.Among them,20 cases Sandwich's suture after aneurysmectomy, 7 cases intracardiac plastic operation.Coronary artery bypass grafting(CABG) were performed on all the patients,the number of vascular grafting were mean 3 1±1 2.Among them 15 transmyocardial laser revascularization(TMLR),mean 29 8±9 5 channels each patient.7 cases intra-aortic balloon pumping after operation. Results 27 successful operations,1 operative deaths,5 Low cardiac output after operation,21 patients with angina were released after discharge,imporoving the cardiac function mean Ⅰ～Ⅱ classes. Conclusion It is effective to use of ventricular fibrillation left ventricular drainage with hypothermia,non-crosslamping the flow of aorta to protect the muscles of heart.The key to elevate the curetive effect is combined treatment:left ventricle reconstruction,CABG and TMLR.