激光心肌血管重建术治疗重症冠状动脉性心脏病

Treatment of Severe Coronary Artery Disease with CO_2 Laser Transmyocardial Revascularization

目的 总结 7例重症冠状动脉性心脏病激光心肌血管重建术 (TML R)的经验。 方法 按加拿大心脏病协会 (CCS)心绞痛分级 ,7例患者术前心绞痛分级为 3.6± 0 .7,冠状动脉弥漫性病变平均为 2 .8± 0 .6支 ,全身麻醉下左前外侧第 5肋间进胸 ,暴露左心室壁进行 TML R,平均打孔 32 .5个。 结果 术后 1个月内心绞痛消失 ,6例随访 1年心绞痛无复发 ,心绞痛级别改变差别具有显著性意义 (P<0 .0 5 ) ,射血分数增加。单光子发射计算机体层摄影术(SPECT)检查心肌缺血区缩小。 结论 TML R能缓解重症冠状动脉心脏病患者的心绞痛 ,改善心肌血供 ,促进休眠心肌的复原 ,提高心肌收缩力。

Objective To summarize the treatment of 7 cases of severe coronary artery disease with CO 2 laser transmyocardial revascularization(TMLR). Methods The mean preoperative angina class (Canadian Cardiovascular Society, CCS), number of diseased coronary arteries were 3.6±0.7 and 2.8±0.6 respectively. All the patients underwent left anterolateral thoracotomy through the fifth intercostal space under general anesthesia, the left ventricule was exposed and then TMLR was performed. The mean channels in TMLR was 32.5. Results The symptoms of angina disappeared during the first postoperative month, with no relapse reported in the first follow-up year. There was significant difference in the angina class (P<0.05), ejection fraction also increased. The ischemia region of the heart decreased through the single photon emission computed tomographic(SPECT) test. Conclusion TMLR can relieve angina and improve life quality of patients with severe coronary artery disease. It can accelerate the recovery of dormant myocardium and enhance the contractility.