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目的 回顾分析 88例左室内补片心室成型治疗巨大室壁瘤的临床经验和手术效果。方法 88例患者中男 72例 ,女 16例 ,年龄 5 3～ 77(平均 6 6 )岁。手术前 74例有心绞痛 ;88例均有明确心肌梗死史 ,2 3例有多次心肌梗死史。冠状动脉造影示梗阻性病变在左主干 (LM) 2 2例次、左前降支 (LAD)88例次、对角支 5 5例次、回旋支 4 8例次、右冠状动脉 30例次。左室射血分数 (LVEF) 35 %± 17% (18%～5 4 % ) ,其中 >4 5 % 35例 ,4 5 %～ 30 % 36例 ,<30 % 17例。除 4例室壁瘤位于心脏下壁外 (下壁心肌梗死所致 ) ,其余 84例室壁瘤均位于心脏前壁和心尖 ,为前壁大面积梗死所致。同时伴需手术矫正的瓣膜功能不全 2 8例。 88例患者均在全身麻醉、体外循环 (CPB)下进行。切开室壁瘤后取净腔内血栓 ;采用 2 0Prolene线 ,将一合适大小的椭圆型补片缝闭室壁瘤的颈部即内口 ,将室壁瘤隔离 ,同时环缩室壁瘤内口 (内荷包 )的作用。特别注意将室间隔的大面积梗死区隔离到补片外 ,剪去外侧部分瘤体 ,连续缝合关闭心室切口 ,完成心内补片左室重建。 87例同时冠状动脉旁路手术 (人均旁路 1.87支 ) ;同期心脏瓣膜手术 2 8例。结果 88例均顺利度过手术。平均主动脉阻断时间 6 8’ ,CPB10 3’。 16例患者需主动脉内球囊反搏 (I
Objective To retrospectively analyze the clinical experience and surgical outcomes of 88 cases of left ventricular patch ventriculogenesis for giant ventricular aneurysm. Methods A total of 88 male and female patients, 72 males and 16 females, ranging in age from 53 to 77 (mean, 66). Preoperative 74 patients had angina pectoris; 88 patients had a clear history of myocardial infarction, 23 cases had multiple myocardial infarction history. Coronary angiography showed obstructive lesions in 22 cases of left main trunk (LM), 88 cases of left anterior descending artery (LAD), 55 cases of diagonal branches, 48 cases of collateral circulation and 30 cases of right coronary artery. Left ventricular ejection fraction (LVEF) 35% ± 17% (18% ~ 54%), including> 45% 35 cases, 45% ~ 30% 36 cases, <30% 17 cases. In addition to 4 cases of aneurysm located outside the heart wall (inferior wall caused by myocardial infarction), the remaining 84 cases of aneurysm are located in the anterior wall of the heart and apex, due to large anterior infarction. At the same time with surgical correction of valvular dysfunction in 28 cases. All 88 patients under general anesthesia and cardiopulmonary bypass (CPB). After the aneurysm was removed, the thrombus in the lumen was taken out. Using 20 Prolene wires, a suitable size of oval patch was used to sew the neck of the aneurysm, ie, the internal orifice, to isolate the aneurysm and to contract the aneurysm Inner mouth (the purse) role. Special attention to the large interventricular septal infarction area isolated to the patch, cut the lateral part of the tumor, continuous suture closure of the ventricular incision to complete the left ventricular reconstruction of cardiac patch. 87 cases of simultaneous coronary artery bypass surgery (per capita bypass 1.87); heart valve surgery in the same period 28 cases. Results 88 cases were successfully surgically treated. Mean aorta blocking time 6 8 ’, CPB10 3’. 16 patients required intra-aortic balloon pump (I