左心室巨大室壁瘤手术治疗的中远期随访研究

目的了解左心室巨大室壁瘤手术治疗的中、远期效果. 方法采用多次信访、电话随访和门诊复查相结合的方法, 对58例左心室巨大室壁瘤行手术治疗后生存的56例患者中的49例进行了随访,随访率87.5% ,随访时间(47.6±22.4)个月,随访时间最长者90.0个月. 结果患者随访期内死亡10例,5年生存率为63.7%.术后患者左心室舒张末径有明显缩小;术后29.0个月左心室射血分数与术前相比,有显著提高.所有患者均无再次心肌梗死发生,心绞痛复发6例,程度较术前减轻.NYHA心功能分级由术前的(2.5±0.7 )级转为(1.3±0.5)级.统计分析显示,左心室舒张末径大于70 mm 及左心室射血分数小于35%,为独立相关危险因素. 结论左心室巨大室壁瘤手术治疗患者,中、远期疗效较好,绝大部分无心绞痛发生,生活质量提高,生存率与国外报道相似.

Operative outcome of patients with left ventricular giant aneurysm: mid-term follow-up in 49 patients

OBJECTIVE: To assess the mid-term outcome of the patients with left ventricular aneurysm repaired, and analyze the factors influencing early and late mortality and morbidity. METHODS: From January 1992 to November 1998, 58 patients underwent surgical repair for postischemic left ventricular aneurysm. In the 56 survivals, 49 patients (87.5%) were followed-up for an average of 47.6 months (the longest time was 90.0 months). RESULTS: Early mortality rate was 3.4% (2 patients). In the follow-up period (mean 47.6 +/- 22.4 months), 10 patients died. The 5-year survival rates were 63.7%. The left ventricular end-diastolic diameter and left ventricular ejection fraction were improved significantly 29.0 months after operation. There was significant improvement in mean NYHA (from class 2.5 +/- 0.7 to 1.3 +/- 0.5). Of the survivors, 43 (87.8%) were free from angina, and 7 had arrhythmias. Multivariate analysis showed that left ventricular end-diastolic diameter larger than 70 mm and left ventricular ejection fraction lower than 35% were independent risk factors. 33% patients were free from drugs. CONCLUSION :Left ventricular aneurysm repair is an important therapeutic intervention and can be performed successfully. Patients who could benefit from the operation are those with a normal postoperative contraction pattern. Cardiac surgical procedures;