急性心肌梗死合并室间隔穿孔患者的临床特点及预后因素分析

目的总结分析急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者的临床特点。方法纳入首都医科大学附属北京朝阳医院1999年1月至2018年10月共收治AMI 16038例,其中合并VSR患者44例,对这44例AMI合并VSR患者的临床资料进行回顾性分析。结果44例AMI合并VSR患者中男性24例(54.5%),女性20例(45.5%),平均年龄(71.0±6.5)岁;前壁心肌梗死患者(包括累及前壁的心肌梗死)35例(79.5%),非前壁心肌梗死9例(20.5%)。手术治疗9例,其中7例为室间隔缺损介入封堵术,2例外科手术(1例为室间隔修补术+冠状动脉旁路移植术+室壁瘤切除术,1例为室间隔修补术+冠状动脉旁路移植术+瓣膜修补术)。术后心功能改善情况均较显著,除2例封堵术患者院内死亡外,其余手术患者生存期均大于1年。结论VSR是AMI少见但严重的并发症,手术治疗的近期预后明显优于非手术治疗,介入封堵治疗在改善症状及预后等方面发挥出日益重要的作用。

Clinical characteristics and prognostic factors of acute myocardial infarction with ventricular septal rupture

Objective To summarize and analyze the clinical characteristics of acute myocardial infarction(AMI)with ventricular septal rupture(VSR).Methods Among the 16038 AMI patients admitted and treated in our hospital from January 1999 to October 2018,a total of 44 patients with VSR.The clinical characteristics were retrospectively analyzed.Results Among the 44 patients with AMI complicated with VSR,there were 24(54.5%)male and 20(45.5%)female,the average age was(71.0±6.5)years old,including 35(79.5%)patients secondary to anterior wall myocardial infarction,9(20.5%)patients secondary to inferior posterior wall myocardial infarction.Surgical treatment was performed in 9 cases,7 with percutaneous ventricular septal defect occlusion,and 2 cases with open thoracic ventricular septal repair(1 case of ventricular septal repair+coronary artery bypass grafting+ventricular aneurysm resection and 1 case of ventricular septal repair+coronary artery bypass grafting+valvular repair,respectively).There were 2 cases died and the rest 4 cases all survived longer than 1 year.Conclusions VSR is a rare but serious complication of AMI,and the short-term prognosis of surgical treatment is significantly better than conservative treatment.Interventional occlusion therapy plays an increasingly important role in improving symptoms and prognosis.