急性心肌梗死并发室间隔穿孔的临床特点分析

目的分析急性心肌梗死并发室间隔穿孔的临床特点,判断患者预后。方法我院1994年6月～2006年7月共收治2027例急性心肌梗死患者,其中17例患者出现室间隔穿孔,并对其临床和超声心动图资料进行回顾性分析。结果我院急性心肌梗死并发室间隔穿孔的发病率为0.84%。17例室间隔穿孔患者中,9例合并高血压;12例前壁心肌梗死。11例冠状动脉造影检查均为2支以上血管病变;10例患者的梗死相关血管闭塞。超声心动图检查左心室平均直径(54.1±6.2)mm,左心室射血分数(40.4±10.8)%;10例室壁瘤形成,穿孔位置多在室间隔近心段的1/3处,穿孔直径(9.5±3.9)mm。内科保守治疗疗效较差,病死率82.35%。结论急性心肌梗死并发室间隔穿孔多发生在老年前壁心肌梗死患者,内科保守治疗病死率高。

Analysis of clinical features in patients with ventricular septal rupture complicating acute myocardial infarction

Objective To provide the evidence for treatment and evaluation of prognosis of the ventricular septal rupture after acute myocardial infarction by analyzing clinical characteristics.Methods Clinical data of seventeen patients with ventricular septal rupture complicating acute myocardial infarction in our hospital between 1994 and 2006 were analyzed retrospectively.Results Of 2 027 patients with acute myocardial infarction,17 were proved to have ventricular septal rupture.The incidence of ventricular septal rupture after AMI was 0.84%.Nine patients had hypertension and 12 patients were diagnosed as acute anterior wall infarction.Coronary arteriography and ventriculography were done in 11 patients and two coronary arteries at least were found to have stenosis.Total occlusion of infarct-related arteries was found in 10 of 11 patients.The average size of left ventricle was 54.1±6.2 mm.Average ejection fraction was 40.4%±10.8%.The sites of septal rupture mostly were located at the septum adjacent to cardiac apex.The average size of rupture was 9.5±3.9 mm.In addition,the fatality rate was high in patients receiving conservative medical treatment(82.35%).Conclusion The septal rupture after acute myocardial infarction mostly happened in aged patients with anterior wall infarction.The fatality rate was high in patients who received conservative medical treatment.