冠心病合并左心室室壁瘤外科治疗临床分析

Surgical treatment of coronary heart disease complicated with left ventricular aneurysm

目的评价手术治疗冠心病合并左心室室壁瘤的临床效果。方法回顾性分析52例冠心病合并左心室室壁瘤患者的临床资料,其中行单纯折叠术9例,线形缝合术28例,心内膜环缩术15例,并同期行冠状动脉旁路移植术和二尖瓣成形术或附壁血栓清除术。比较术前、术后早期(出院前)及术后24个月患者左心室舒张末期内径、左室射血分数及NYHA心功能分级,评价手术治疗效果。结果 52例患者手术过程均顺利,术后早期因低心排血量综合征死亡2例;术后早期及术后24个月患者左心室舒张末期内径((55.4±3.0)、(56.3±3.1)mm)较术前((62.7±3.7)mm)明显缩小,左室射血分数((49.5±2.9)%、(51.4±4.2)%)及NYHA心功能分级((1.9±0.3)、(1.8±0.8)级)较术前((41.0±4.0)%、(3.3±0.6)级)提高,差异均有统计学意义(P<0.05);余50例随访24个月无再发心绞痛及心肌梗死发生。结论对冠心病合并左心室室壁瘤患者,根据室壁瘤部位、大小选择手术方式,并同期完全心肌再血管化及矫治瓣膜功能,临床疗效满意。

Objective To evaluate the clinical effect of surgical treatment of coronary heart disease（CHD）complicated with left ventricular aneurysm.Methods The clinical data of 52 patients with CHD complicated with left ventricular aneurysm were retrospectively analyzed.Nine patients underwent simple placation,28 patients underwent linear repair,and 15 underwent endoventricular patch plasty,followed by coronary artery bypass grafting and mitral valvuloplasty or mural thrombectomy in all patients.The left ventricular end-diastolic dimension（LVEDD）,left ventricular ejection fraction（LVEF）and NYHA heart function classification were compared in all patients before operation,in the early stage and 24 months after operation to evaluate the effect of surgical treatment.Results All patients were completed the operation successfully.Two patients died of low cardiac output syndrome in the early period after operation.The LVEDD was significantly shorter in the early stage（（55.4±3.0）mm）and 24 months after operation（（56.3±3.1）mm）than that before operation（（62.7±3.7）mm）（P〈0.05）.LVEF and NYHA were significantly higher in the early stage（（49.5±2.9）%,1.9±0.3）and 24 months after operation（（51.4±4.2）%,1.8±0.8）than those before operation（（41.0±4.0）%,3.3±0.6）（P〈0.05）.All 50 patients were discharged with no recurrent angina or acute myocardial infarction during 24-month follow-up survey.Conclusion To chose different surgical management according to the position and size of left ventricular aneurysm,synchronized complete revascularization and perfect valve repair can achieve a satisfactory clinical result in the treatment of CHD complicated with left ventricular aneurysm.