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Clinical Analysis of Patients with Coronary Artery Disease and Left Ventricular Aneurysm Undergoing Coronary Artery Bypass Grafting without Concomitant Surgical Ventricular Restoration

ObjectiveTo analyze clinical outcomes of coronary artery bypass grafting (CABG) without concomitant surgical ventricular restoration (SVR) for patients with coronary artery disease (CHD) and left ventricular aneurysm (LVA). MethodsA total of 105 patients with CHD and LVA underwent surgical treatment in Wuhan Asia Heart Hospital from January 2008 to December 2012. Among them,74 patients were found to have no clear boundary LVA,poor wall motion or no obvious contradictory wall motion during surgical exploration,and didn't received SVR,including 59 male and 15 female patients with their age of 60.96±9.09 years. Coronary angiography showed 5 patients with single-vessel disease,10 patients with double-vessel disease,45 patients with triple-vessel disease,and 14 patients with left main and triple vessel disease. Intraoperative findings showed no clear boundary LVA in 30 patients,apical thinning without obvious LVA in 29 patients,LVA without obvious contradictory wall motion but thickening of the apex in 15 patients. All the 74 patients received CABG including 62 patients undergoing on-pump CABG and 12 patients undergoing off-pump CABG. Seventy patients received left internal mammary artery to left anterior descending anastomosis,and 2 patients received endarterectomy of the left anterior descending coronary artery. For moderate to severe mitral regurgitation,3 patients received concomitant mitral valvuloplasty,and 2 patients received concomitant mitral valve replacement. One patient received concomitant aortic valve replacement for severe aortic stenosis. ResultsPostoperatively,2 patients (2.7%) died of malignant arrhythmia and hypoxic ischemic encephalopathy respectively. Six patients received intra-aortic balloon pump (IABP) support for low cardiac output syndrome,perioperative myocardial infarction and malignant arrhythmias. Seventy patients were followed up after discharge for 24-60 (43±12) months. During follow-up,left ventricular thrombus was found in 8 patients,disappeared within 1 year after warfarin treatment in 5 patients,and no thromboembolic event happened. Echocardiogram showed that LVA disappeared in 18 patients (25.7%). Ejection fraction (EF) at discharge,6 months and 1 years after discharge were significantly higher than preoperative EF (EF at 6 months after discharge versus preoperative EF:44%±6% vs. 39%±5%). Left ventricular end-diastolic diameter (LVEDD,LVEDD at 6 months after discharge versus preoperative LVEDD:54.37±6.28 mm vs. 59.24±6.24 mm) and left ventricular end-systolic diameter (LVESD) were significantly reduced compared with preoperative values (P<0.01). But as time went by,LVEDD and LVESD gradually became larger than those values at discharge. ConclusionFor patients with CHD and LVA,CABG without SVR,which is decided according to actual surgical exploration,can significantly improve postoperative EF,LVEDD and LVESD,but left ventricular enlargement may happen progressively after discharge.

胸部創傷致升主動脈-右室瘺一例

冠狀動脈旁路移植術后并發癥及死亡原因分析

目的分析冠狀動脈旁路移植術后并發癥發生和死亡的原因，以采取有效的措施進行防治。 方法回顧性分析2011年1月至2012年12月武漢亞洲心臟病醫院行冠狀動脈旁路移植術1 146例患者的臨床資料，其中男823例，女323例；年齡（62.27±8.39）歲；體重（67.60±10.73）kg。對冠狀動脈旁路移植術后并發癥發生原因和死亡原因進行分析。 結果圍術期死亡15例，手術死亡率為1.30%（15/1 146）。死亡原因包括：惡性心律失常4例、多器官功能衰竭4例、低心排血量綜合征2例、心臟壓塞1例、循環衰竭1例、術中新發主動脈夾層1例、圍術期心肌梗死1例、術中主動脈插管脫落致嚴重酸堿平衡失調1例。手術后發生并發癥131例，發生率為11.43%（131/1 146）。并發癥包括：出血38例、呼吸功能衰竭35例、傷口愈合不良29例、圍術期心肌梗死14例、急性腦梗死4例、惡性心律失常4例、Ⅲ度房室傳導阻滯安裝永久起搏器2例、心臟壓塞2例、急性腸梗阻1例、肺栓塞1例、酸堿平衡失調1例。上述并發癥均經相應的處理好轉或治愈。隨訪1 131例，隨訪時間為3個月至2年。隨訪期間因感染、呼吸功能衰竭、大面積腦出血、大面積腦梗塞、惡性心律失常、大量心包積液引起心臟壓塞死亡5例。其余患者隨訪期間無心絞痛復發，無心肌梗死發生。 結論冠狀動脈旁路移植術后常見并發癥為手術出血、呼吸功能衰竭、傷口愈合不良、圍手術期心肌梗死等。惡性心律失常、多器官功能衰竭、低心排血量綜合征是冠狀動脈旁路移植術后死亡的主要原因。圍術期應采取積極有效的措施進行預防和治療，以降低并發癥發生率及死亡率。