目的:分析总结肥厚型心肌病合并左心室心尖部室壁瘤患者的临床特征。方法:2007-01至2013-01共1 194例肥厚型心肌病患者在北京同仁医院接受检查,其中23例(1.94%)合并左心室心尖部室壁瘤,男19例,女4例。所有患者均除外冠心病,并接受超声...目的:分析总结肥厚型心肌病合并左心室心尖部室壁瘤患者的临床特征。方法:2007-01至2013-01共1 194例肥厚型心肌病患者在北京同仁医院接受检查,其中23例(1.94%)合并左心室心尖部室壁瘤,男19例,女4例。所有患者均除外冠心病,并接受超声心动图和心血管造影检查。结果:23例患者中,左心导管检查证实其中21例患者左心室中部存在梗阻,其中7例患者同时合并左心室流出道梗阻。21例左心室梗阻患者收缩期压差为(56.8±12.9)mm Hg(1 mm Hg=0.133 k Pa);另外2例患者为心尖肥厚型心肌病。患者的左心室室壁最大厚度为(21.8±6.3)mm,左心室横径(39.4±5.2)mm。心电图检查提示,3例患者合并阵发性室性心动过速。心血管造影检查发现,6例患者合并冠状动脉肌桥,并且均位于冠状动脉前降支。(2.7±1.3)年随访过程中,5例患者发生心血管不良事件,其中2例患者充血性心力衰竭加重,3例患者发生室性心动过速。结论:肥厚型心肌病伴发左心室心尖部室壁瘤最常见于左心室中部肥厚型梗阻性心肌病患者,其中部分患者同时合并左心室流出道梗阻。这些患者心血管不良事件发生率高,早期准确诊断对指导临床治疗至关重要。展开更多
Background A large transmural myocardial infarction often results in a dyskinetic or akinetic left ventricular aneurysm （LVA）. This study aimed to explore the early and long-term clinical outcomes and to identify pr...Background A large transmural myocardial infarction often results in a dyskinetic or akinetic left ventricular aneurysm （LVA）. This study aimed to explore the early and long-term clinical outcomes and to identify predictors for survivals and hospital re-admission after the repair of left ventricular aneurysm. Methods We followed up 497 patients who had undergone LVA repair from a single center in China between 1995 and 2005. The perioperative parameters were recorded. Risk factors for early mortality and long-term results were analyzed by multivariate Logistic regression. Cox＇s proportional hazard model was used to calculate risk factors for major adverse cardiac and cerebrovascular events, cause of death and re-admission. Kaplan-Meier curve was employed to analyze long-term survival. Results The operative mortality was 2.0%. The long-term mortality was 11.1% and cardiac causes contributed to 61.8% of the overall long-term mortality. Four hundred and thirty-two patients survived during the follow-up period and 37.5% of them had been re-admitted at least one time. One hundred and five patients experienced major adverse cardiac and cerebrovascular events. Survival analysis exhibited that the probability of survival at 1 and 5 years after operation was 96% and 86% respectively. Previous atrial fibrillation was the independent risk factor for early mortality. Independent risk factors for long-term mortality were poor left ventricular ejection fraction and stroke, and risk factors for cardiac mortality were intraventricular block, stroke and poor left ventricular ejection fraction. Stroke, intraventricular block and advanced age were independent risk factors for major adverse cardiac and cerebrovascular events, and New York Heart Association （NYHA） class Ill-IV was the only risk factor for hospital re-admission. Conclusions Postinfarction LVA can be repaired and satisfying early and long-term clinical outcome can be obtained. Endoventricular circular plasty technique is the better choice than linear repair i展开更多
Background Acute myocardial infarction can result in left ventricularaneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia andthromboembolic events. This study evaluates results achieved w...Background Acute myocardial infarction can result in left ventricularaneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia andthromboembolic events. This study evaluates results achieved with a modified linear closure of leftventricular aneurysms during off-pump coronary artery bypass surgery. Methods From January 2001 toMay 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysmduring off-pump coronary artery bypass surgery. Repair was completed on the beating heart tominimize ischaemia and allow assessment of wall function and viability to guide closure. Allpatients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia.The majority (75% ) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejectionfraction was 26% ±9%. The mean left ventricular, end diastolic diameter was (57. 5 ±7. 1) mm. Theventricular preoperative and postoperative performances were compared. χ~2 test and Student' s ttest were used to analyse the outcomes. A P value less than 0. 05 was considered significant.Results Hospital mortality was 1. 3% (1/75). Coronary artery bypass was performed with an average of(3. 3 ±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. Themean NYHA class and ejection fraction increased significantly (P < 0.001 ) . The mean leftventricular, end diastolic diameter decreased significantly (P <0. 001). Conclusions Surgicalclosure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. Theoperation is associated with a low inhospital mortality and morbidity. A postoperative improvementin the early term cardiac functions and symptoms and quality of life was documented, increasing ourexpectations of an increased long-term survival.展开更多
文摘目的:分析总结肥厚型心肌病合并左心室心尖部室壁瘤患者的临床特征。方法:2007-01至2013-01共1 194例肥厚型心肌病患者在北京同仁医院接受检查,其中23例(1.94%)合并左心室心尖部室壁瘤,男19例,女4例。所有患者均除外冠心病,并接受超声心动图和心血管造影检查。结果:23例患者中,左心导管检查证实其中21例患者左心室中部存在梗阻,其中7例患者同时合并左心室流出道梗阻。21例左心室梗阻患者收缩期压差为(56.8±12.9)mm Hg(1 mm Hg=0.133 k Pa);另外2例患者为心尖肥厚型心肌病。患者的左心室室壁最大厚度为(21.8±6.3)mm,左心室横径(39.4±5.2)mm。心电图检查提示,3例患者合并阵发性室性心动过速。心血管造影检查发现,6例患者合并冠状动脉肌桥,并且均位于冠状动脉前降支。(2.7±1.3)年随访过程中,5例患者发生心血管不良事件,其中2例患者充血性心力衰竭加重,3例患者发生室性心动过速。结论:肥厚型心肌病伴发左心室心尖部室壁瘤最常见于左心室中部肥厚型梗阻性心肌病患者,其中部分患者同时合并左心室流出道梗阻。这些患者心血管不良事件发生率高,早期准确诊断对指导临床治疗至关重要。
文摘Background A large transmural myocardial infarction often results in a dyskinetic or akinetic left ventricular aneurysm （LVA）. This study aimed to explore the early and long-term clinical outcomes and to identify predictors for survivals and hospital re-admission after the repair of left ventricular aneurysm. Methods We followed up 497 patients who had undergone LVA repair from a single center in China between 1995 and 2005. The perioperative parameters were recorded. Risk factors for early mortality and long-term results were analyzed by multivariate Logistic regression. Cox＇s proportional hazard model was used to calculate risk factors for major adverse cardiac and cerebrovascular events, cause of death and re-admission. Kaplan-Meier curve was employed to analyze long-term survival. Results The operative mortality was 2.0%. The long-term mortality was 11.1% and cardiac causes contributed to 61.8% of the overall long-term mortality. Four hundred and thirty-two patients survived during the follow-up period and 37.5% of them had been re-admitted at least one time. One hundred and five patients experienced major adverse cardiac and cerebrovascular events. Survival analysis exhibited that the probability of survival at 1 and 5 years after operation was 96% and 86% respectively. Previous atrial fibrillation was the independent risk factor for early mortality. Independent risk factors for long-term mortality were poor left ventricular ejection fraction and stroke, and risk factors for cardiac mortality were intraventricular block, stroke and poor left ventricular ejection fraction. Stroke, intraventricular block and advanced age were independent risk factors for major adverse cardiac and cerebrovascular events, and New York Heart Association （NYHA） class Ill-IV was the only risk factor for hospital re-admission. Conclusions Postinfarction LVA can be repaired and satisfying early and long-term clinical outcome can be obtained. Endoventricular circular plasty technique is the better choice than linear repair i
文摘Background Acute myocardial infarction can result in left ventricularaneurysm, which may in turn cause congestive heart failure, ventricular arrhythmia andthromboembolic events. This study evaluates results achieved with a modified linear closure of leftventricular aneurysms during off-pump coronary artery bypass surgery. Methods From January 2001 toMay 2004, 75 patients were operated on for nonruptured, postinfarctional, left ventricular aneurysmduring off-pump coronary artery bypass surgery. Repair was completed on the beating heart tominimize ischaemia and allow assessment of wall function and viability to guide closure. Allpatients presented with symptoms of angina and congestive heart failure or ventricular arrhythmia.The majority (75% ) of the patients were in NYHA functional class Ⅲ or Ⅳ. Preoperative ejectionfraction was 26% ±9%. The mean left ventricular, end diastolic diameter was (57. 5 ±7. 1) mm. Theventricular preoperative and postoperative performances were compared. χ~2 test and Student' s ttest were used to analyse the outcomes. A P value less than 0. 05 was considered significant.Results Hospital mortality was 1. 3% (1/75). Coronary artery bypass was performed with an average of(3. 3 ±1.2) grafts per patient. At the time of followup, all the patients had no symptoms. Themean NYHA class and ejection fraction increased significantly (P < 0.001 ) . The mean leftventricular, end diastolic diameter decreased significantly (P <0. 001). Conclusions Surgicalclosure of left ventricular aneurysm can be performed during off-pump coronary artery bypass. Theoperation is associated with a low inhospital mortality and morbidity. A postoperative improvementin the early term cardiac functions and symptoms and quality of life was documented, increasing ourexpectations of an increased long-term survival.
