摘要
目的分析评估急性心肌梗死(AMI)并发室间隔穿孔(VSR)患者行经导管VSR介入封堵术的疗效。方法回顾性分析2009年5月至2015年5月由解放军总医院心内科行介入封堵术治疗的6例AMI并发VSR患者,研究其临床特点、介入手术实施情况及术后并发症等,并随访至今。结果 6例患者中5例封堵成功(手术成功率5/6),1例打开封堵伞后出现封堵伞固定欠佳,即刻撤回封堵伞,于术后半年死于心力衰竭。5例成功封堵的患者中,4例封堵后少量残余分流,1例封堵后出现急性左心衰竭,经积极治疗后好转。5例成功封堵的患者院内死亡2例(围术期死亡率2/5),其中1例封堵后心脏压塞,并于术后3 h死亡,1例患者术后因患者家属拒绝继续使用主动脉内球囊反搏(IABP)辅助循环,在撤出IABP后随即出现心原性休克并死亡;其余3例随访至今均存活,超声心动图示患者心功能均显著改善,且无心力衰竭发生。结论介入封堵术是治疗AMI并发VSR的一种较为可靠的手段,能改善患者心功能,降低患者死亡率。
Objective To evaluate the clinical efficacy of interventional occlusion of ventricular septal rupture（ VSR） complicating acute myocardial infarction（ AMI）. Methods Six patients with VSR complicated after AMI underwent transcatheter interventional occlusion in Chinese PLA General Hospital between May 2009 to May 2015 were retrospectively analyzed. Their clinical features,interventional treatment protocols, and occurance of postoperative complications were studied. Results Among the 6 patients,VSR were successfully occluded in 5 patients. One patient failed the operation due to instability of occluder after it was deployed and the occluder was retrieved. The paitents died of heart failure6 months later. Among the 5 patients with successful closure,4 patients presented mild residual shunt after occlusion and acute left heart failure occurred in 1 patient after operation. Two patients died during hospital stay after operation. Between them,one patient died 3 hours after operation because of cardiac tamponade and the other patient died of cardiogenic shock after withdrawal from IABP. Three patients were followed up until now and follow up echocardiography showed satisfactory cardiac function without heart failure.Conclusions Transcatheter occlusion was a reliable therapy for patients with ventricular septal rupture complicated in acute myocardial infarction which could improve cardiac function and reduce mortality.
出处
《中国介入心脏病学杂志》
2016年第2期83-87,共5页
Chinese Journal of Interventional Cardiology
关键词
急性心肌梗死
室间隔穿孔
介入封堵术
Acute myocardial infarction
Ventricular septal rupture
Transcatheter interventional occlusion
