急性心肌梗死并发室间隔穿孔的临床分析

Clinical analysis of acute myocardial infarction complicated by ventricular septal rupture

回顾性分析22例急性心肌梗死（AMI）并发室间隔穿孔（VSR）患者的临床资料特点.AMI并发VSR患者多合并高血压、高脂血症、2型糖尿病史.梗死部位以前壁或广泛前壁心肌梗死为主,部分患者合并室壁瘤形成.心功能kil-lip分级主要以心功能Ⅱ级、Ⅲ级为主.超声心动图示室间隔缺损直径为4～19 mm,穿孔部位大多位于室间隔近心尖部,部分为后间隔、肌部、室间隔多个穿孔,1例合并心脏破裂.单纯内科保守治疗及主动脉内球囊反搏术支持治疗的患者均死亡,1例室间隔封堵术后择期行支架植入术及4例外科手术治疗均存活。

To analyze clinical symptoms of 22 patients with acute myocardial infarction （AMI） complicated by ventricular septal rupture （VSR）.Of most patients with acute myocardial infarction complicated by ventricular septal perforation,they had a history of hypertension,hyperlipemia,or 2 diabetes.Most of the infarction was local or extensive anterior myocardial infarction,some cases had a merger with aneurysm formation.Cardiac function of killip classification was mainly grade Ⅱ,grade Ⅲ.Diameter of VSR was measured by echocardiography,mainly 4 ～ 19 mm,the majority of cases were located in interventricular septum near the apex,others were located in back or muscle portions interventricular septum,small part with multiple performation.1 patient was cardiac rupture.Patients died after single conservative treatment or intra-aortic balloon IABP support treatment.However,1 patient who received elective stent implantation after septal occluder and 4 patients who received surgery survived.