左室重建术治疗左室室壁瘤(附32例报告)

目的探讨左室重建术治疗左室室壁瘤患者的临床效果.方法对32例心肌梗死后形成左室室壁瘤的患者进行室壁瘤切除及左室重建术,并同期进行冠脉搭桥术,其中2例行瓣膜置换术.结果左室重建术后,射血分数(EF)由术前的29.3%±6.2%增加到40.4%±5.6%(P＜0.05),左室舒张末期内径(LVDD)由(59.6±1.8)cm减小至(50.4±1.6)cm(P＜0.05),左室舒张末期容量(LVEDV)由(168±12)ml减少至(102±11)ml(P＜0.01),较术前均有明显改善.1例术后住院30d内死亡.随访1～30个月,1例死亡.结论左室重建术治疗左室室壁瘤对于恢复左室几何形状,改善心功能是非常有效的方法.     

左心室假腱索的形态学观察

目的观察左心室假腱索的形态特征,为探讨假腱索与多种临床现象产生的机制提供依据.方法用68例成人离体心脏标本,观察、测量左心室假腱索的位置、数目、直径等指标.结果 52例发现假腱索共118条,出现率为76.5%,平均每例(1.74±1.08)条.假腱索多附着于室间隔和前、后乳头肌,乳头肌和游离壁,室间隔和游离壁之间.其长度为(15.26±7.86)mm,中间段和两端的直径分别为(0.67±0.61)mm和(0.92±0.67)mm.结论左心室假腱索是心腔内的解剖结构,对心脏功能可能有一定影响.     

左室室壁瘤的手术治疗

目的　完善左室室壁瘤的手术治疗。方法　 2 8例左室室壁瘤病人在全麻低温体外循环下行单纯室壁瘤心外折迭术 1例 ,室壁瘤切除后三明治缝合术 2 0例 ,心腔内成形术 7例。所有病例术中均行冠状动脉旁路移植术 ,人均搭桥 3.1± 1.2支。其中左室壁激光心肌再血管化 15例 ,人均打孔 2 9.8± 9.5个。结果　 2 7例手术成功 ,手术死亡 1例 ,术后低心排 5例。心绞痛明显缓解 ,心功能得以改善。结论　左室重建 ,冠脉搭桥和激光打孔并用可提高疗效     

Massive false aneurysm of the left ventricle with dysphagia

A patient with a massive false aneurysm of the left ventricle following myocardial infarction is described. The pseudoaneurysm compressed the esophagus causing severe dysphagia, and contributed to advanced terminal cachexia.     

左室假腱索与室性期前收缩的关系研究

[目的]探讨左心室假腱索与室性期前收缩的关系。[方法]选择超声心动图检出的左心室假腱索(LVFT)的健康人60例(左室假腱索组),随机选取无左心室假腱索的健康体检者60例(对照组),所有病例均行24 h动态心电图记录,分析比较两组室性期前收缩的发生率。[结果]左室假腱索组60例中有45例发生室早,发生率为75%,对照组60例中12例发生室早,发生率为20%,两组比较差异有显著性意义(P<0.05)。而45例发生室早的假腱索中,横型的左室假腱索者30例,发生率为66.7%,纵型的左室假腱索者15例,发生率为33.3%,两组比较差异有显著性意义(P<0.05)。[结论]左室假腱索是健康人室早的独立危险因素,左室假腱索横型者室早发生率较纵型者高。     

心肌梗死后左室室壁瘤的外科治疗

目的评价冠心病左室室壁瘤(LVA)术后近期及中期疗效.方法总结21例左心室室壁瘤手术者的临床资料.术前左心室舒张末内径(72±14.5)mm,左心室射血分数0.33±0.12.冠状动脉单支病变6例,双支病变3例,3支病变12例.合并中度二尖瓣反流7例,二尖瓣及主动脉瓣中重度反流1例;合并梗死后室间隔破裂1例.术前心功能Ⅲ级15例,Ⅳ级6例.常规浅低温体外循环(32～34℃).行冠状动脉旁路移植术(CABG)及室壁瘤切除术.结果LVA位于心尖部15例,前壁4例,后壁2例,有附壁血栓3例.LVA切除加二尖瓣及主动脉瓣置换1例,同时行CABG 20例,梗死部隔离并行CABG1例.全组无住院及术后随访死亡者.手术前后相比,左心室收缩末容量指数(69±18,42±16)、舒张末容量指数(118±51,79±2)、射血分数(0.33±0.12,0.49±0.10)及心功能分级(3.1±0.9,1.6±0.5)均有明显改善.结论冠心病室壁瘤切除术后疗效满意,同时再血管化,适宜的左室重建以及有效的心肌保护,是手术成功的关键     

室性早搏与左室假腱索

目的　探讨室性早搏与左室假腱索的关系。方法　采用PhlipSD - 80 0型彩色多谱勒诊断仪 ,检测 9382例心脏病患者 ,并进行分析。结果　 15 3例发现左室假腱索 ,其中 10 9例无器质性心脏疾病 ,仅有室性早搏。结论　室性早搏与左室假腱索有相关性     

Myocardial rupture. Major left ventricular infarct rupture treated by infarctectomy

A myocardial rupture that occurred during anesthesia induction for infarctectomy was successfully repaired, and the patient is well and free of symptoms 10 1/2 months later.     

Hypertrophic cardiomyopathy with apical left ventricular aneurysm: a case report

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Hypertrophic cardiomyopathy with apical left ventricular aneurysm: a case report

Morphological diversity is one characteristic of hypertrophic cardi omyopathy (HCM), but it is not common that HCM is associated with apical left ve ntricular aneurysm (LVA) without evidence of a coronary artery lesion. We repor t on such a case and review the pathogenesis, manifestations and diagnostic meth ods by collecting the few available papers published on this topic.     

False left ventricular aneurysm as a complication of open heart surgery.

A false aneurysm developed at the site of left ventricular venting in an 8-year-old boy who had undergone aortic valve commissurotomy under cardiopulmonary bypass. The diagnosis was made by clinical examination and chest radiography and confirmed by left ventricular cineangiography. The aneurysm was successfully resected.     

Off-pump anteroapical aneurysm plication for left ventricular post-infarction aneurysm: long-term results

Background  The temporal response to off-pump anteroapical aneurysm plication has not been well defined. We have evaluated the long-term clinical and functional results of this technique and compared the efficacy with the patch modeling repair.

Methods  From March 2005 to May 2010, 163 (115 men and 48 women) consecutive patients were operated on for post-infarction left ventricular aneurysm (LVA), 54 patients underwent patch remodeling (group A) and 109 patients underwent off-pump anteroapical aneurysm plication repair (group B). All patients had simultaneous coronary revascularization, other operative procedures included septoplasty in eight and ablation of ventricular tachycardia in six. Follow-up ranged from 1 to 5 years, short-term and mid-term outcomes, including complications, cardiac function, and mortality, were assessed.

Results  Early mortality was 1.8% for all patients (group A 1 death vs. group B 2 deaths, not significant (NS)). Peri-operative support included intraaortic balloon pumping in 16 (9.8%), (group A 6 patients vs. group B 10 patients, NS) and inotropic drugs in 84 (51.5%), (group A 34 vs. group B 50, NS). During a mean follow-up of (3.7±0.8) years, eight patients died, with four due to cardiac-related causes. No patient required transplantation, and two required use of an implantable cardioverter-defibrillator for ventricular tachycardia. Survival at 1 and 5 years was 95% and 86%, respectively. It did not differ significantly between group A and group B. Functional class improved from 2.90±0.59 to 1.65±0.54 among the mid-term survivors (P <0.001), with no significant difference between the two groups. Pre-operative risk factors for mortality or poor function were ejection fraction (EF) <0.35 (OR=7.9, 95% CI 1.6–40.0); congestive heart failure (CHF) (OR=4.4, 95% CI 1.0–19.0); end-systolic volume index (ESVI) >80 ml/m² (OR=3.7, 95% CI 1.0–14.0); and advanced age >70 years (OR=2.4, 95% CI 1.0–12.0).

Conclusions  The technique of off-pump anteroapical aneurysm plication associated with coronary grafting can be performed with low operative mortality, providing good symptomatic relief and long-term survival, and similar results can be achieved with patch modeling repair.

     

Aortic rupture during radiofrequency catheter ablation of left ventricular tachycardia

To the editor： Radiofrequency ablation is an effective and relatively safe nonsurgical method for treatment of ventricular tachycardia （VT）, its complications including cardiac perforations, cardiac tamponade, heart block, etc. Here, we report a patient who developed aortic rupture during ablation.     

小儿左室假腱索的二维超声心动图检测（附464例报告）

应用二维超声心动图，从２２８９例小儿超声心动图检查中发现左室假腱索４６４例，结合文献，搪塞了左室假腱索与心脏杂音，室性早博及临床症状的关系与意义，并对其机理进行了初步分析。我们认为二维超声心动图是检测左室假腱索的敏感方法，在确定有无器质性心脏病及解释临床症状方面均有意义。