摘要
目的 总结 4 2例室壁瘤切除左心室成形加冠状动脉搭桥无死亡的经验。 方法 4 2例左心室室壁瘤患者 ,男 4 1例、女 1例 ,平均年龄 (5 5 5± 2 4 )岁 (4 0～ 6 8岁 )。 38例有不稳定性心绞痛 ,术前合并严重室性心律失常 10例 ,其中有心室颤动病史 2例 ,反复发作室性心动过速 8例 ,合并高血压病 2 6例 ,糖尿病 3例 ,重症慢性阻塞性肺疾病 1例 ;心功能 (NYHA)Ⅲ级 32例 ,Ⅳ级 10例 ;合并二尖瓣轻至中度关闭不全 6例。 4 2例经左心室造影和手术证实为解剖性室壁瘤 ,位于前间壁 4 1例、下壁 1例。左心室射血分数 (LVEF)平均 4 1% (17%～ 6 3% ) ,其中LVEF <4 0 % 2 9例。 33例采用Jatene术式 ,8例Dor术式 ,1例Cooley术式 ,其中 10例在心脏跳动下完成左心室成形术。左主干病变 7例 ,3支病变 30例 ,2支病变 6例 ,单纯左前降支病变 5例。全部患者同期行冠状动脉搭桥术 ,乳内动脉使用率 10 0 %。术中证实左心室内附壁血栓 2 1例。平均体外循环时间 (135± 11)min ,阻断升主动脉(78± 10 )min。 结果 术后平均住院天数 (13 1± 1 2 )d ,住ICU(2 8± 0 6 )d。使用主动脉内气囊反搏 7例 (17% ) ,术后发生顽固性室性心动过速 1例 ,胸骨哆开 1例 ,术后早期渗血、二次开胸止血 1例。术后左心室前后径、舒张末?
Objective To summarize the experience in performing left ventricular aneurysmectomy (LVA) with geometric reconstruction and concomitant coronary artery bypass grafting (CABG) without mortality. Methods Forty-two patients underwent LVA with geometric reconstruction and concomitant CABG. Forty-one patients were male, one was female with mean age of (55.5±2.4 )years (40- 68 years). Preoperative cardiac function was NYHA class Ⅲ in 32 patients and class Ⅳ in 10. Thirty-eight patients had unstable angina pectoris and 10 had the history of severe ventricular arrythmia. Eight patients had ventricular tachycardia. Preoperative left ventricular ejection fraction (LVEF) was 41% (17%-63%), LVEF was less than 40% in 29 cases. Left ventricular anatomic aneurysms were confirmed by ventriculography. Thirty-three cases underwent Jatene technique; 8 cases, Dor technique, and 1 case, Cooley technique. Mural thrombi were found in 21 patients and were completely removed. CABG was concomitantly performed in all patients. All of the left anterior descending artery was bypassed with left internal mammary artery and the other target vessels with saphenous vein. Mean cardiopulmonary bypass time was (135±11) minutes and aortic clamping time was (78±10) minutes. Results No hospital mortality occurred and all patients were discharged. Postoperative reexploration for bleeding in 1 patient. The diameter and end systolic and diastolic volume of left ventricle were significantly decreased to nearly normal after operation. Operative ejection fraction had a tendency to increase but without significance (P>0.05). Conclusions LVA with geometric reconstruction and concomitant CABG could not only improve heart function but also eliminate ventricular arrythmia. The clinical result was excellent.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2003年第12期917-919,共3页
Chinese Journal of Surgery
基金
解放军"十五"医药卫生科研资助项目 ( 0 1MA10 0 )
关键词
室壁瘤
心脏肿瘤
心肌血管重建术
冠状动脉疾病
治疗
Left ventricular aneurysm
Myocardial revascularization
Coronary disease
Treatment outcome
