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目的 评价Amplatzer肌部室间隔封堵器封堵室间隔穿孔和经皮冠状动脉腔内成形术 (PTCA)及冠脉支架术联合介入方法治疗急性心肌梗死合并室间隔穿孔的可行性、安全性和疗效。方法 3例患者术前均经超声心动图检查诊断为急性心肌梗死并发室间隔穿孔 ,入院后强化纠正心衰治疗 ,先完成室间隔封堵术 ,再择期完成冠脉PTCA及支架术。结果 (1)室间隔破裂封堵结果 :分别选用直径为 12mm、10mm和 16mmAmplatzer肌部室间隔封堵伞成功封堵。 1例有少量残余漏。 (2 )冠脉造影及介入结果 :2例为前降支单支 90 %和 95 %狭窄 ,前降支中段分别植入支架 ;另 1例为 3支血管病变 ,前降支中段 10 0 %关闭 ,前降支和右冠脉植入 2枚支架。PTCA及支架术即刻成功率为 10 0 % ,无并发症发生。 (3)近期和远期预后 :3例病人心功能均得到明显改善。 2例于术后 10d出院 ,1例 (3支病变病例 )于术后 4d并发脑血管意外 ,2周后死亡。 1例 1年后复查 ,超声心动图左室内径由 5 7mm降至 5 3mm ,EF由 0 .34增至 0 .5 6 ,室间隔仍有少量残余漏 ;另 1例 6个月复查 ,超声心动图左室内径由 5 6mm降至 5 2mm ,EF由 0 34增至 0 6 2 ,室间隔封堵处无漏血。 2例均无心绞痛 ,心功能 2级。结论 应用Amplatzer肌部室间隔封堵器封堵室间隔穿孔和PTCA及
Objective To evaluate the feasibility, safety and efficacy of Amplatzer muscular interventricular septal occluder closure percutaneous transluminal septal perforation and percutaneous transluminal coronary angioplasty (PTCA) combined with coronary stenting in the treatment of acute myocardial infarction complicated with ventricular septal perforation . Methods All 3 patients were diagnosed as acute myocardial infarction complicated by ventricular septal perforation by echocardiography preoperatively. After admission, they were treated with heart failure correction. Ventricular septal occlusion was performed before PTCA and stenting. Results (1) Ventricular septal rupture occlusion results: Respectively selected diameter 12mm, 10mm and 16mm Amplatzer muscular ventricular septal blocking plug successfully. One patient had a few residual leaks. (2) Coronary angiography and interventional outcomes: two patients had a single 90% and 95% stenosis of anterior descending coronary artery, and a stent was implanted in the middle of the anterior descending artery. The other one had 3 vessel lesions, 10% Close, anterior descending artery and right coronary artery implanted two scaffolds. Immediate success rate of PTCA and stenting was 10%, no complications occurred. (3) short-term and long-term prognosis: 3 patients with cardiac function have been significantly improved. Two patients were discharged at 10 days after operation. One patient (3 lesions) developed cerebrovascular accident 4 days after operation and died after 2 weeks. 1 case after a year of review, left ventricular diameter echocardiography from 5 7mm to 5 3mm, EF from 0.34 to 0. 56, there is still a small amount of residual ventricular septal leak; the other 6 cases were reviewed, ultrasound Cardiac left ventricular diameter decreased from 5 6mm 5 2mm, EF increased from 0 34 to 0 6 2, no septal plug at the leak. No angina was found in 2 cases and heart function was grade 2. Conclusion Amplatzer muscular ventricular septal occluder should be used to seal ventricular septal perforation and PTCA