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关键词：心肌疾病；心力衰竭，充血性；心脏外科手术
【摘要】 目的 对终末期扩张型心肌病患者采用外科左心室部分切除术减小左心室容积，并观察缓解心力衰竭(心衰)的疗效。方法 4例患有进行性加重的充血性心衰患者的病因分别为原发性(2例)、瓣膜性(1例)和缺血性(1例)心肌病，所采用的术式包括“乳头肌间室壁切除”1例及“超乳头肌室壁切除”3例(后者含二尖瓣替换)。同期手术还包括主动脉瓣替换2例和冠状动脉搭桥1例。结果 所有患者都顺利脱离体外循环，并在术后(25±2)小时拔除气管插管。心输出量由术前(2.0±0.2)升/min增至术后(4.1±0.3)升/min(P=0.001)。除1例患者3周后死于细菌性纵隔感染所致败血症外，另3例平均14天后出院。随访(最多达22个月)证实这3例患者均保持在纽约心脏协会心功能Ⅰ级。结论 左心室部分切除术为终末期扩张型心肌病患者缓解心衰症状，早期临床效果良好。
Left ventricular volume reductionfor the treatment of end-stage dilated cardiomyopathy
AnthonyP.C. Yim, M.B.Izzat, WAN Song. Division of Cardiothoracic Surgery, Department of Surgery,The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin ,Hong Kong
【 Abstract 】 Objective To study the effect of partial left ventriculectomy(PLV)in the alleviation of heart failure for patients with end-stage dilated cardiomyopathy.Methods Four patients(mean age 57 years) underwent PLV in our hospital. Preoperatively, all patients hadadvanced symptomatic congestive heart failure due to idiopathic (n=2), valvular (n=1), andischemic cardiomyopathy (n=1). Interpapillary (n=1) or extrapa-pillary (n=3) types of PLVresection were performed, the latter necessitating mitral valve replacement in 3 patients.Associated procedures were aortic valve replacement (n=2) and coronary artery bypassgrafting (n=1). Results All patients were successfully weaned from cardiopulmonary bypass,and were extubated 25±2 hours after surgery. Postoperative cardiac output increased from2.0±0.2 to 4.1±0.3 L/min(P=0.001). One patient died 3 weeks after surgery of sepsis dueto acute bacterial mediastinitis. Average hospital stay for the other three patients was14 days. At a follow-up up to 22 months, all three patients were in NYHA functional classI. Conclusion PLV isassociated with early favorable clinical outcome in the alleviation of heart failure forpatients with end-stage dilated cardiomyopathy.
【 Key words 】 myocardial diseases heart failure, congestive heart surgery
终末期扩张型心肌病的发病率呈上升趋势 ......
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