急性心肌梗死后室间隔穿孔的外科治疗中长期随访结果

Mid-long term follow-up of surgical treatment for ventricular septal rupture after acute myocardial infarction

目的评估急性心肌梗死后室间隔穿孔的外科治疗长期随访结果。方法回顾性分析2011年6月至2019年6月北部战区总医院接受外科手术治疗的心梗后合并室间隔穿孔患者26例,其中男性17例(65.4%),女性9例(34.6%),平均年龄(62.1±9.4)岁。全部患者均接受全麻低温体外循环下施行室间隔穿孔心内修复,同期行冠状动脉旁路移植术23例,左心室成形8例,二尖瓣置换术2例,三尖瓣成形2例。观察围术期手术疗效并进行随访时间3~96个月,平均(33.0±30.1)个月。结果全组患者无手术死亡,效果良好。体外循环时间69~184(129.4±40.0)min,升主动脉阻断时间41~100(66.0±18.3)min。术前出现肾功能不全行持续血液净化(CRRT)3例,持续至术后,均无需长期透析。术前体外膜肺氧合(ECMO)1例。随访期间术后2月、60个月因心衰分别死亡1例,术后24个月因胃癌晚期及27个月结肠癌晚期各死亡1例。存活22例患者心功能分级(NYHA)Ⅰ级17例,Ⅱ级4例,Ⅳ级1例。Ⅳ者为ECMO及CRRT抢救患者,1年后仍存活,残余漏1.2 cm。2例术后36个月脑出血,患肢肌力均Ⅳ级。结论急性心肌梗死后室间隔穿孔患者外科治疗具有满意的长期疗效。

Objective To evaluate the long-term outcomes of surgical treatment of ventricular septal rupture after acute myocardial infarction.Methods The date of 26 consecutive patients with ventricular septal rupture after acute myocardial infarction operated in our institution from June 2011 to June 2019 was analyzed.Among them,there were 17 males(65.4%)and 9 females(34.6%),with an average age of(62.1±9.4)years.All the patients underwent repairment of ventricular septum rupture under general anesthesia and cardiopulmonary bypass(CPB).Meanwhile,23 coronary artery bypass graft(CABG),8 left ventricular DOR plasty,2 mitral replacement and 2 tricuspid repair were performed.The results of perioperative period were analyzed.The patients were followed up for a period of 3 months to 8 years[(33.0±30.1)months].Results There was no operative mortality.CPB time was 69~184(129.4±40.0)min and aortic clamp cross time was 41~100(66.0±18.3)min.There were three cases received dialysis pre-operation.Extracorporeal membrane oxygenation(ECMO)had to be applied due to circulatory collapse pre-operation in one case and was removed two days after the operation.During follow-up,two patients died of heart failure at two months and sixty months after operation respectively;one died of gastric cancer at 24 months and one died of colon cancer at 27 months.Among the survived 22 patients,17 had New York Heart Association(NYHA)functional classⅠ,four had NYHAⅡand one had NYHAⅣ;cerebral hemorrhage occurred in two patients 36 th month after the procedure and survived with impaired limb movement.Conclusion The long-term outcomes of surgical treatment of ventricular septal rupture were satisfactory.