动力性心肌成形术远期结果

Long-term result of dynamic cardiomyoplasty

目的 报道 3例扩张性心肌病患者接受动力性心肌成形术后的远期结果。 方法3例男性患者接受动力性心肌成形术 ,年龄分别为 36、45、6 2岁 ,术前心功能Ⅲ级 (NYHA) 1例 ,Ⅳ级2例。术后对患者定期随访 ,分析血液动力学参数、临床心功能及心脏形态等指标。 结果 患者无手术死亡 ,术后早期即出现血液动力学指标改善、心脏扩大趋势减缓、临床症状缓解、活动耐力增加、生活质量提高 ,3例患者心功能均为Ⅰ级。 1例患者术后 1年 7个月死于心律失常 ;2例长期存活者 3年后部分血液动力学指标下降 ,心脏呈扩大趋势 ,心功能减低。 1例患者存活 4年 6个月死于心力衰竭 ;1例现仍存活 ,心功能Ⅱ级。 结论 动力性心肌成形术在术后相当长的一段时间内能改善扩张性心肌病、心力衰竭患者的生活质量 ,提高心功能。

Objective To evaluate the long-term outcome of dynamic cardiomyoplasty in patients with dilated cardiomyopathy. Methods Three male patients with dilated cardiomyopathy at age of 36, 45 and 62 years were underwent dynamic cardiomyoplasty from 1994 to 1995. Postoperative follow-up were performed. The data of hemodynamic parameters, functional grade and dimension of heart were analyzed. Results There was no operative death in these patients. All patients recovered eventlessly. From early postoperative stage, the hemodynamic parameters and clinical symptoms were improved and the patients′ exercise tolerance augmented. The quality of life of patients was enhanced significantly. All patients showed NYHA functional grade I. One patient died of severe arrhythmia at the 19th postoperative month. In 2 long-term survivors, the hemodynamic parameters and heart function were declined and the heart tended to be dilated after 3 postoperative years. One patient died of congestive heart failure at 4.5 postoperative years. One patient still survived 7 years after operation and remained heart functional grade Ⅱ. Conclusions Dynamic cardiomyoplasty can significantly improve the functional class and quality of life in patients with dilated cardiomyopathy within a considerable long postoperative period.