张婷,王乐丰,夏坤,李维铭,姜峰,张智勇,孙昊,郭宗生,徐立,杨新春

• 1:首都医科大学附属北京朝阳医院心脏中心北京高血压重点实验室
• 2:北京中医药大学附属东直门医院心血管科

摘要(Abstract)：

目的总结分析急性心肌梗死(AMI)合并室间隔穿孔(VSR)患者的临床特点。方法纳入首都医科大学附属北京朝阳医院1999年1月至2018年10月共收治AMI 16 038例,其中合并VSR患者44例,对这44例AMI合并VSR患者的临床资料进行回顾性分析。结果 44例AMI合并VSR患者中男性24例(54.5%),女性20例(45.5%),平均年龄(71.0±6.5)岁;前壁心肌梗死患者(包括累及前壁的心肌梗死)35例(79.5%),非前壁心肌梗死9例(20.5%)。手术治疗9例,其中7例为室间隔缺损介入封堵术,2例外科手术(1例为室间隔修补术+冠状动脉旁路移植术+室壁瘤切除术,1例为室间隔修补术+冠状动脉旁路移植术+瓣膜修补术)。术后心功能改善情况均较显著,除2例封堵术患者院内死亡外,其余手术患者生存期均大于1年。结论 VSR是AMI少见但严重的并发症,手术治疗的近期预后明显优于非手术治疗,介入封堵治疗在改善症状及预后等方面发挥出日益重要的作用。

关键词(KeyWords)： 室间隔穿孔;急性心肌梗死

Abstract:

Keywords:

基金项目(Foundation): 北京市医院管理中心消化内科学协同发展中心消化专项重点项目子课题（XXZ0607）

作者(Author): 张婷,王乐丰,夏坤,李维铭,姜峰,张智勇,孙昊,郭宗生,徐立,杨新春

参考文献(References)：

• [1] Hu XY, Qiu H, Qiao SB, et al. Clinical analysis and risk stratifi cation of ventricular septal rupture following acute myocardial infarction. Chin Med J(Engl), 2013, 126(21):4105-4108.
• [2] Jones BM, Kapadia SR, Smedira NG, et al. Ventricular septal rupture complicating acute myocardial infarction:a contemporary review. Eur Heart J, 2014, 35(31):2060-2068.
• [3] Ng Ramford,Yeghiazarians Y. Post myocardial infarction cardiogenic shock:a review of current therapies. J Intensive Care Med,2013,28(3):151-165.
• [4]李汉美，项理，许建屏，等.急性心肌梗死后合并室间隔穿孔外科修复105例：阜外医院16年随访结果.中国胸心血管外科临床杂志，2019, 26(5):451-456.
• [5]胡小莹，邱洪，乔树宾，等. 70例急性心肌梗死合并室间隔穿孔患者的临床分析.中国循环杂志，2013,28(2):107-110.
• [6] Zhong X,Zhou G,Huan Z,et a1.Small septal vessel occlusion results in big damage:ventricular septal dissection and rupture. Eur Heart J,2018,39(26):2506-2517.
• [7]刘子衿，缪黄泰，聂绍平.急性心肌梗死后心脏破裂的危险因素分析.中华心血管病杂志，2016, 44(10):862-867.
• [8]孙王乐贤，刘会玲，张娜，等.急性ST段抬高型心肌梗死合并解剖性室壁瘤的多重危险因素分析.中华心血管病杂志，2015,43(1):51-55.
• [9] Topaz O, Taylor AL. Interventricular septal rupture complicating acute myocardial infarction:from pathophysiologic features to the role of invasive and noninvasive diagnostic modalities in current management. Am J Med, 1992, 93(6):683-688.
• [10] Crenshaw BS, Granger CB, Birnbaum Y, et al. Risk factors,angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction. GUSTO-I(Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries)trial investigators. Circulation, 2000, 101(1):27-32.
• [11]李佳，罗晓亮，乔树宾，等.急性心肌梗死并发游离壁破裂和室间隔穿孔患者的临床特征及预后比较.中国循环杂志，2019,34(7):653-657.
• [12]冯涛，陈小平，冯慧芳，等.急性心肌梗死患者梗死相关冠状动脉侧支循环形成的影响素.心脏杂志，2016, 28(1):53-55.
• [13] Johansson S, Bergstrand R, Schlossman D, et al. Sex diff erences in cardioangiographic fi ndings after myocardial infarction. Eur Heart J,1984, 5(5):374-381.
• [14] Kim EK, Choi JH, Song YB, et al. A protective role of early collateral blood flow in patients with ST-segment elevation myocardial infarction. Am Heart J, 2016,171(1):56-63.
• [15] Kamioka N, Block PC. Septal rupture closure:Still a challenge.Catheter Cardiovasc Interv,2018,92(6):1116-1117.
• [16] Malhotra A, Patel K, Sharma P, et al. Techniques, timing&prognosis of post infarct ventricular septal repair:a re-look at old dogmas. Braz J Cardiovasc Surg,2017, 32(3):147-155.
• [17] Schlotter F, de Waha S, Eitel I, et al. Interventional postmyocardial infarction ventricular septal defect closure:a systematic review of current evidence. EuroIntervention, 2016,12(1):94-102.
• [18] Faccini A, Butera G. Techniques, timing, and prognosis of transcatheter post myocardial infarction ventricular septal defect repair. Curr Cardiol Rep,2019,21(7):59-64.
• [19] Wei X, Yi W, Xu X, et al. Transthoracic occlusion for secundum atrial septal defects unsuitable for transcatheter occlusion approach. J Thorac Cardiovasc Surg, 2011, 142(1):113-119.
• [20]王乐丰，王红石，杨新春，等.急性心肌梗死合并室间隔穿孔Amplatzer伞封堵成功一例.中华心血管病杂志，2002, 30(12):763-764.
• [21] Fujimoto K, Kawahito K, Yamaguchi A, et al. Percutaneous extracorporeal life support for treatment of fatal mechanical complications associated with acute myocardial infarction. Artif Organs, 2001, 25(12):1000-1003.
• [22] Park JY, Park SH, Oh JY, et al. Delayed ventricular septal rupture after percutaneous coronary intervention in acute myocardial infarction. Korean J Intern Med, 2005, 20(3):243-246.
• [23]刘博罕，王广义，郭军，等.急性心肌梗死并发室间隔穿孔患者行介入封堵术的疗效评估.中国介入心脏病学杂志，2016, 24(2):83-87.
• [24] Siondalski P, Jarmoszewicz K, Rogowski J, et al. Emergency surgical closure of postinfarction ventricular septal defect on the beating heart. Interact Cardiovasc Thorac Surg, 2007, 6(2):160-162.