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Proposal of a new classification: “sealed type” postinfarction left ventricular free wall rupture
General Thoracic and Cardiovascular Surgery ( IF 1.2 ) Pub Date : 2021-11-02 , DOI: 10.1007/s11748-021-01730-1
Keiji Uchida 1 , Shota Yasuda 1 , Tomoki Cho 1 , Yoshiyuki Kobayashi 1 , Atsushi Matsumoto 1 , Yusuke Matsuki 1 , Tomoyuki Minami 1 , Keiichiro Kasama 1 , Daisuke Machida 1 , Shinichi Suzuki 1
Affiliation  

Objective

Postinfarction left ventricular free wall rupture (FWR) has been classified into blow-out type and oozing type. However, considering past papers, oozing type included the cases in which the bleeding had spontaneously stopped or sealed, and the distinction between blow-out type and oozing type was not always clear. We classified FWR into the BO type (combination of blow-out type and oozing type) with continuous bleeding and sealed type and clarified the pathophysiology of the sealed type.

Methods

Thirty-five patients who underwent surgical treatment for FWR during the past 21 years were retrospectively evaluated.

Results

Twenty-one patients (60%) were sealed. Comparing the sealed type with the BO type, the incidence of sudden collapse with acute onset was significantly lower (sealed type; 62%, BO type; 100%, P = 0.0118), and there were more cases of transport from outside the hospital (76%, 43%, P = 0.0453). Significantly few cases had electro-mechanical dissociation immediately before surgery (10%, 71%, P = 0.0001). In the sealed type, median sternotomy was performed in 9 patients (43%), and subxiphoid drainage was performed in 12 (57%). Fifteen patients (71%) were supported by IABP postoperatively, and re-rupture occurred in 3 patients without IABP. Long-term outcomes were significantly better in the sealed type than in the BO type.

Conclusion

Sixty percent of postinfarction ventricular free wall rupture was the sealed type. Median sternotomy and sutureless repair with postoperative IABP support were reliable treatments. Subxiphoid drainage and strict blood pressure control with IABP may be acceptable surgical strategies in elderly, frail patients.



中文翻译:

提出新分类:“密封型”梗死后左心室游离壁破裂

客观的

梗死后左心室游离壁破裂(FWR)分为爆裂型和渗出型。然而,考虑到过去的论文,渗出型包括出血自发停止或封闭的情况,并且喷出型和渗出型之间的区别并不总是很清楚。我们将FWR分为持续出血的BO型(喷出型和渗出型)和封闭型,阐明了封闭型的病理生理学。

方法

回顾性评估了过去 21 年中接受 FWR 手术治疗的 35 名患者。

结果

21 名患者 (60%) 被密封。密封型与BO型相比,急性起病的突然塌陷发生率显着降低(密封型;62%,BO型;100%,P  =0.0118),院外转运病例较多( 76%、43%,P  = 0.0453)。显着少数病例在手术前即刻发生机电分离(10%,71%,P  = 0.0001)。在密封型中,9 例患者(43%)进行了正中胸骨切开术,12 例患者(57%)进行了剑突下引流。15例(71%)患者术后接受IABP支持,3例无IABP再破裂。密封型的长期结果明显优于 BO 型。

结论

60% 的梗死后心室游离壁破裂为密封型。正中胸骨切开术和术后 IABP 支持的无缝线修复是可靠的治疗方法。对于年老体弱的患者,剑突下引流和 IABP 严格控制血压可能是可接受的手术策略。

更新日期:2021-11-02
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