急性心梗后室间隔穿孔的临床特征及外科治疗

急性心肌梗塞后室间隔穿孔(简称VSR)是心梗病人一种较少见的并发症,预后极差。我们自1985年5月至1999年10月对12例VSR进行手术治疗。入院后应用强心利尿扩血管及IABP辅助治疗,并在中度低温体外循环下行穿孔修补术。结果死亡5例,死亡率为41.7％。VSR临床表现以右心衰和心源性休克为特征,及早正确的围术期处理和早期手术是治疗的关键。

The Clinical Specificity and Operation of the Ventricular Septal Rupture after Acute Myocardial Infarction

Aim:We have operated 12 patients of the ventricular septal rupture (VSR) after acute myocardial infarction from the May of 1988 to the October of 1999. There were five male patients and seven female patients. The mean age was 5.8 years. the mean time from acute myocardial infarction to VSR was 5.1 days. The site of VSR was mainly in the anterior septal and the mean diameter was 14.4mm. All patients were operated. The time from VSR to operation was 17.3 days. All patients were operated by apiece of Dacron except 4 patients by directly suturing. The results was that 2 patients had residual leakage (16.7 % )and 5 patents died early after operation(4l .7% ) .This study drawn the following conclusion: most of the VSR patients were advanced age, female and initial myocardial infarction. It' s mortality is much higher. It' s clinical manifestation is chiefly the right heart failer and cardiogenic shock. The key of its treatment is prompt and right perioperative treatment and early operaton. At present time, the best treatment approach needs to be explored because its early operative mortality is still higher.