心肌梗死后室间隔穿孔:非选择性病例的外科临床结果

doi:10.19723/j.issn.1671-167X.2019.06.022

Abstract

Abstract:

Objective: To observe the clinical prognosis and surgical treatment results in patients with postinfarction ventricular septal rupture, and to discuss the risk factors,methods & timing of treatment.Methods: From January 2006 to February 2019, 23 patients with postinfarction ventricular septal rupture were admitted to the department of cardiac surgery,Peking University People’s Hospital, including 12 males (52.2%) and 11 females (47.8%), aged (64.26 ±11.09) years. Among them, 18 cases underwent operation, and 5 cases did not receive surgical treatment. The clinical data and follow-up data were summarized retrospectively.Results: Among the patients treated with operation, the average time from perforation to operation was (19.39 ±13.67) d, including 6 cases (33.3%) of perforation within 1 week, 6 cases (33.3%) within 2 to 4 weeks and 6 cases (33.3%) more than 4 weeks. Emergency surgery was performed in 11 cases (61.1%) because of hemodynamic instability, and selective operation in 7 cases (38.9%). Direct enlarged patch was used in 13 cases (72.2%), and some infarct exclusion techniques were used in 5 patients (27.8%). In 18 cases, coronary artery bypass grafting was performed in 12 cases (66.7%). Of all the surgical patients, 7 (38.9%) died during hospitalization. Compared with the survival patients, the perioperative death patients had earlier perforation [(1.83±0.75) d vs. (5.22 ±4.66) d, P=0.019] and higher emergency operation rate (100% vs. 36.4%, P=0.009) and lower simultaneous bypass grafting rate (28.6% vs. 90.1%, P=0.008). The median follow-up time was 2 years (3 months to 10 years). 2 patients died of heart failure in 2 months after operation, and 9 cases (50.0%) survived for a long time. Of the 5 patients who had not been treated, 2 died while waiting for operation, and 3 patients who refused surgery died within 1 week after discharge.Conclusion: Surgery is an effective treatment for patients with acute myocardial infarction complicated with ventricular septum perforation. The best time for operation should be determined by real-time evaluation and monitoring, combined with the situation of patients. Concomitant coronary artery bypass grafting may be beneficial to these patients.

Key words: Acute myocardial infarction, Postinfarction ventricular septal rupture, Risk factors, Operation opportunity

CLC Number:

R654.2

Qing GAO,Yu CHEN,Gang LIU,Sheng-long CHEN,Sui-xin DONG. Clinical results after surgical treatment for non-selective case with postinfarction ventricular septal rupture[J].Journal of Peking University(Health Sciences), 2019, 51(6): 1103-1107.

Figures/Tables 3

Table 1

Comparison of the perioperative death group and survival group"

	Death group(n=7)	Survival group(n=11)	Test value	P
Age/years, $\overset{?}{x}$ $x ?$ ±s	63.43±12.34	62.55±12.52	0.277	0.606
Gender,n(%)			-0.470	0.638
Male	3(42.9)	6(54.5)
Female	4(57.1)	5(45.5)
Time from infarction to perforation/d	1.83±0.75	5.22±4.66	7.236	0.019
Cardiogenic shock,n(%)	3(42.9)	4(36.4)	-0.464	0.643
Hypertension,n(%)	5(71.4)	7(63.6)	-0.332	0.740
Hyperlipidemia,n(%)	2(28.6)	3(27.3)	-0.058	0.954
Diabetes,n(%)	1(14.3)	3(27.3)	-0.991	0.322
LVED/cm	5.66±0.91	5.37±0.70	0.803	0.384
LVEF/%	55.60±10.10	55.30±14.60	1.713	0.210
Perforation size/cm	1.31±0.47	1.52±0.53	0.227	0.640
BNP/(ng/L)	1 285.00±946.30	1 490.50±818.00	0.094	0.767
Preoperative IABP,n(%)	6(85.7)	6(54.5)	-1.329	0.184
Preoperative mechanical ventilation,n(%)	0(0)	3(27.3)	-1.471	0.141
Preoperative CRRT,n(%)	0(0)	1(0.09)	-0.798	0.425
Time from perforation to operation/d	15.00±15.67	22.18±12.18	0.919	0.352
Emergency operation,n(%)	7(100.0)	4(36.4)	-2.624	0.009
Simultaneous CABG,n(%)	2(28.6)	10(90.1)	-2.658	0.008
Postoperative residual shunt,n(%)	2(28.6)	3(27.3)	-0.493	0.622

Table 1

Figure 1

Figure 2

References 13

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