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首页> 外文期刊>Journal of cardiac surgery. >A critical evaluation of results of partial left ventriculectomy.
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A critical evaluation of results of partial left ventriculectomy.

机译：对部分左室切除术的结果进行严格评估。

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BACKGROUND: Because of the variation in the surgical procedures designed to reduce ventricular radius, along with differences in hospital care, it is difficult to disentangle the factors that may contribute to the success or failure of the partial left ventriculectomy. METHODS AND RESULTS: We undertook partial left ventriculectomy in 18 patients, 10 suffering from idiopathic dilated cardiomyopathy and 8 from ischemic heart disease. We assessed the amount of reduction in wall stress, the systolic thickening of the ventricular wall, and the extent of connective tissue in the excised segment of the wall. Of the overall group, six patients died, three from infarction, one of stroke, one with asystole, and one with ventricular fibrillation. The mean decrease in measured mesh tension was 40% (p < 0.001). Most patients exhibited improvements postoperatively in terms of the systolic thickening of the posterior and superior free walls of the left ventricle. In those in whom the events could be monitored, life-threatening arrhythmias posed complications in three of four patients with ischemic heart disease, and in two of six patients suffering from idiopathic dilated cardiomyopathy. In one patient, death was associated with a transmural alignment of fibrous tissue. CONCLUSIONS: Our measured reductions in myocardial mesh tension were in keeping with the anticipated theoretical reduction in wall stress expected from partial ventriculectomy. The basic concept underscoring surgical maneuvers to reduce ventricular radius, therefore, is sound. A potential trap is the resection of the marginal artery. Critical myofibrosis was a rare complication. Arrhythmias, which are common, can successfully be treated by implantation of antitachycardic and defibrillatory devices.
机译：背景：由于旨在减少心室半径的外科手术方法的变化以及医院护理的差异，很难弄清可能导致部分左心室切除术成败的因素。方法与结果：我们对18例患者进行了部分左心室切除术，其中10例患有特发性扩张型心肌病，另8例患有缺血性心脏病。我们评估了壁应力减少的程度，心室壁的收缩增厚以及壁切除部分的结缔组织范围。在整个组中，有6例患者死亡，3例因梗塞死亡，1例中风，1例患有心律失常，1例患有心室纤颤。测得的网眼张力平均下降40％（p <0.001）。大多数患者在术后左心室后壁和上游离壁的收缩增厚方面表现出改善。在那些可以监测事件的患者中，危及生命的心律失常在缺血性心脏病的四名患者中的三名和特发性扩张型心肌病的六名患者中的两名中引起了并发症。在一名患者中，死亡与纤维组织的透壁排列有关。结论：我们测得的心肌网片张力降低与部分脑室切除术预期的壁应力理论降低预期相符。因此，强调手术操作以减小心室半径的基本概念是合理的。潜在的陷阱是切除边缘动脉。严重的肌纤维化是一种罕见的并发症。常见的心律不齐可以通过植入抗心动过速和除颤设备成功治疗。

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