川崎病合并左主干冠状动脉瘤和室壁瘤的手术疗效

目的:总结川崎病合并左主干冠状动脉窦瘤和室壁瘤的手术疗效及治疗经验。方法:回顾性分析2002年1月至2012年1月期间,经手术治疗的川崎病合并左主干冠状动脉瘤和室壁瘤5例患者的临床资料。手术方法为室壁瘤切除并冠状动脉旁路移植术,并随访6至12个月。结果:术后5例患者均存活,手术成功率100%。左室射血分数术前从平均33%改善至术后近期50%,随访期间为57%(P<0.01);左室舒张末内径从术前平均58mm改善至术后近期49mm,随访平均内径为48mm(P<0.01);心功能分级(NYHA)从术前2.8级改善至术后2.2级,随访期间为1.6级(P<0.05)。随访复查冠状动脉CTA提示冠状动脉瘤瘤径无扩大,桥血管通畅。结论:对于川崎病合并左主干冠状动脉瘤和室壁瘤的患者,瘤径小于10mm时,术中可旷置。

Surgical Treatment of Kawasaki Disease Complicated with Left Main Coronary Artery Aneurysm and Ventricular Aneurysm

Objective: To evaluate the surgical outcomes of cardiac infarction complicated with left main coronary artery aneurysm(LMCAA) and ventricular aneurysm caused by Kawasaki disease(KD) and to summarize the experience.Methods: Five cases of LMCAA caused by KD underwent left ventricular reconstruction and coronary artery bypass during January 2002 to January 2012 were retrospectively analyzed.Results: All the patients were in good state during our follow up.The left ventricular ejection fraction,left ventricular end-diastolic diameter and heart function classification were significantly improved compared to preoperation.Imaging examination showed no enlargement of LMCAA and well blood supply of graft vessels.Conclusion: Management of LMCAA should be individually according to the patient and characteristics of the lesion.It is feasible to ignore the aneurysm during operation while the diameter of aneurysm is less than 10 mm.