Myocardial infarction with left ventricular aneurysm

Overview of left ventricular myocardial infarction, left ventricular myocardial necrosis of the whole layer. About 10 ~ 38% of cases of myocardial necrosis of the fiber was gradually replaced by scar tissue, aneurysm formation. TLC lesion of ventricular bulging outward, cardiac contraction incapacitation or showing abnormal movement. As early as in 1881 right coronary artery obstruction, myocardial infarction, myocardial fibrosis and left ventricular aneurysm of the evolution process has been fully recognized. 1960s left ventricular aneurysm clinical diagnosis rapid progress. 1955 Likoff, Bailey is closed launched aneurysm surgery. 1958 Cooley under extracorporeal circulation in the first aneurysm resection success. Cause pathogenesis of left ventricular aneurysm about 85% at anterolateral area near the apex, in a few cases, cardiac septal surface. Lesions regional ventricular wall thinning, showing a white fibrous scar, a clear border, local epicardial closely with pericardial adhesion. About half of patients with endocardial surface mural thrombus, sometimes showing calcification. Obstructive coronary artery disease was mostly confined to the left anterior descending branch, but also involving a number of support vessels. Left ventricular cavity volume increases, normal part of cardiac hypertrophy. Left ventricular aneurysm so that the lesion loss of myocardial contractility and may have reverse pulse. Beware Room contraction aneurysm bulging outward, and diastolic when retracted, Bo out to left ventricular volume reduction. Normal myocardial contractility strengthened, increasing tension, increased myocardial oxygen demand. VA capacity over the left ventricular end-diastolic volume 15%, the left ventricular end-diastolic pressure. As the row of left ventricular function of blood caused by damage to the left heart failure and gradually worsened. Aneurysm thrombosis once lost, can produce systemic embolism. Clinical manifestations of left ventricular aneurysm patients who have history of angina and myocardial infarction. Common clinical manifestations of short breath and left heart failure, angina, arrhythmias and systemic arterial embolization. Clinical symptoms and the severity of the aneurysm size and left ventricular myocardial normal part of the number and are closely related to functional status. Medical examination : apical region can lay hands on the dispersion of systolic favors or double pulse. Auscultation checks may have heard the first three or four heart sound heart sounds. Indications for surgery : left ventricular aneurysm size, showing clinical congestive heart failure, angina, ventricular tachycardia and systemic embolism should be considered for surgical treatment. Angina in patients with left ventricular aneurysm, according to coronary artery disease branch of the same period of the implementation of coronary bypass grafting. Symptoms of serious heart failure, difficult to control medical treatment, aneurysm size, left ventricular free wall occupy 50% more, multi-vessel coronary disease, and non-VA regional left ventricular systolic function was generally weak case. Surgical treatment of high surgical mortality rates should be carefully considered. Aneurysm small size, and there are no obvious clinical symptoms, and can be closely observed the development of the disease, there is no need to hurry surgery treatment. Aneurysm resection technique : CPB low temperatures combined operations. Chest midline incision, vertical saw sternum, pericardial incision, the right atrium, right atrial appendage to insert incision, the inferior vena cava blood catheter primers, ascending aortic blood to the catheter insertion, or blocked aortic blood flow after heart deep down, in the ascending aorta and injected cold cardioplegic solution. Stop the heart beat, touch aneurysm should be avoided to prevent thrombosis lost, have embolization. VA and pericardial adhesions between osteoporosis can I separated, but if aneurysm and close pericardial adhesions, separation difficulties, can be together with pericardial incision aneurysm, tumor cavity to remove clots and mural thrombus. At this point in the left ventricular cavity filling up gauze to prevent blood clots fall into the aorta or the left atrium. Identify the mitral valve, papillary muscles and fibrous scar tissue aneurysm and normal left ventricular myocardium interface. from the interface of about 0.5 cm cutting aneurysm. Harvesting the aneurysm edge fibrous tissue can be used to reinforce the suture left ventricle and may try to retain normal myocardial tissue. Cleaning with saline ventricular cavity, blood clots clastic net absorption, with thick silk or polyester suture 1 -0 two suture left ventricular incision. With the first layer with polyester pads for the suture through mattress suture, and the second tier for intermittent or continuous suture. Myocardial tissue is relatively fragile, the incision can be placed on both sides of the pads a long polyester, liner suture reinforcement. Sutured the incision should be taken to avoid injury papillary muscles, and, where possible, to retain anterior descending coronary artery was not as suture ligation. VA lesions ventricular septal part of the case, in order to prevent abnormal postoperative ventricular septal campaign need reinforcement or repair the same period fibrosis weak ventricular septal. will mark ventricular septal area sutured wounds in the right side of left ventricular cutting edge of the left ventricular wall aneurysm then sutured incision. Ventricular septal fiber weak area the greater will require intermittent use of suture plication weak, or suture reinforcement panels for ventricular septal weak areas aneurysm again sutured incision, through the needle should panels for the front (Figure 1). (1) Open aneurysm (2) removal of thrombus, remove aneurysm (3) a gasket suture incisions (4) suture reinforcement plans an aneurysm resection aneurysm all sutured incision prior to the left ventricular cavity filled saline residues discharged air. Aortic occlusion clamp open prior to the ascending aorta and the left ventricle inserted needle decompression of exhaust. Rewarming to 35 ℃ heartbeat after the resumption of pump stopped in the right ventricular pacing electrode linking home, facilitate postoperative arrhythmia treatment. Need the same period of implementation of coronary bypass graft cases, the thoracotomy at the same time, free cut standby great saphenous vein. After the first aneurysm resection for the great saphenous vein distal coronary artery anastomosis branch. Removed from the blocked aortic clamp and then clamping or part of the aorta, the major purposes of the proximal ascending aorta saphenous vein anastomosis. Surgical treatment : Surgical mortality in recent years has dropped below 10%. After major surgery early death due to acute heart failure, low output syndrome, a serious rhythm disorders and cerebral vascular embolization. Postoperative symptoms markedly improved, and 7-year survival rate of 60 ~ 80%. Single coronary artery lesions postoperative survival rate than high multivessel disease.