左心室成形术治疗应激性心肌病持续性室壁瘤的临床效果及预后分析

Analysis of clinical results and prognosis of left ventricular plasty in the treatment of Takotsubo cardiomyopathy with persistent ventricular aneurysm

目的:总结应激性心肌病持续性室壁瘤患者经左心室成形术治疗的临床资料,对手术效果及预后情况进行分析。方法:收集2009年1月至2020年5月,我院收治的应激性心肌病合并持续性室壁瘤患者接受左心室成形术临床数据,对术前及术后数据进行比较分析,同时进行门诊及电话随访,对预后情况加以总结分析。结果:入组患者15例,其中女性10例(66.6%),超声心动图均提示为节段性室壁运动异常和心尖部室壁瘤形成,且室壁瘤病史均超过3个月,没有阻塞性冠状动脉病变或急性斑块破裂的冠状动脉造影证据,术前的LVEF为(45.7±6.7)%,血清NT-proBNP为(8739.25±7282.82)ng/L,所有患者均在全麻低温体外循环下行左心室成形术,出院时复查超声心动图提示节段性室壁运动异常及室壁瘤消失,LVEF提升至(57.6±7.4)%,NT-ProBNP下降至(823.4±472.5)ng/L,术前与术后比较,差异有统计学意义(P<0.05),随访时间1~10年,随访过程中无死亡事件发生,无复发病例。结论:应激性心肌病致持续性室壁瘤较为罕见,经外科左心室成形术治疗后,室壁瘤消失,心功能改善,预后好。

Objective:We analyzed the clinical outcomes and prognosis of left ventricular plasty in the treatment of Takotsubo cardiomyopathy with persistent ventricular aneurysm.Methods:We collected the clinical data of patients with Takotsubo cardiomyopathy complicated with persistent ventricular aneurysm who underwent left ventricular plasty from January 2009 to May 2020 in our hospital.The preoperative and postoper-ative data were compared and analyzed.At the same time,outpatient and telephone follow-up were conducted to summarize and analyze the prognosis.Results:There were 15 patients,including 10 females(66.6%).Echo-cardiography showed segmental wall motion abnormality and apical aneurysm formation,and the history of aneu-rysm was more than 3 months.There was no evidence of coronary angiography for obstructive coronary artery dis-ease or acute plaque rupture.After the surgery of left ventricular plasty,LVEF was significantly increased from(45.7±6.7)%to(57.6±7.4)%,and the serum level of NTproBNP was decreased from(8739.25±7282.82)ng/L to(823.4±472.5)ng/L.There were statistically significant differences between preoperative and postoperative(both P<0.05).There was no death or recurrence during the follow-up.Conclusions:Per-sistent ventricular aneurysm caused by Takotsubo cardiomyopathy is rare.After surgical left ventricular plasty,ventricular aneurysm disappeared,cardiac function improved and prognosis was good.