Endocardial Excision: A New Surgical Technique for the Treatment of Recurrent Ventricular Tachycardia
Endocardial Excision: A New Surgical Technique for the Treatment of Recurrent Ventricular Tachycardia
复制标题
心内膜切除术：治疗复发性室性心动过速的新手术技术
作者：
M. Josephson;A. Harken;L. Horowitz
摘要：12例继发于缺血性心脏病的难治性室性心动过速患者接受了手术治疗。术前，通过程序性刺激，每位患者的心动过速可重复地开始和终止。在所有病例中，术中测图将心动过速定位于动脉瘤边缘，这是动脉瘤切除术中不常规切除的部位。在9例病例中，发病区域涉及鼻中隔。在搭桥术中，12例患者中有11例在标准动脉瘤切除术或脑室切除术后仍可诱发心动过速。在术中作图的基础上，切除原动脉瘤区（动脉瘤周长的25-40%）至正常肌肉的心内膜。在一名没有离散性动脉瘤的患者中，通过脑室切开术进行了单独的心内膜切除术。一例手术死亡是由于心源性休克（术前射血分数5%），一例晚期死亡是由于肺动脉真菌性动脉瘤破裂。出院前，所有患者均接受了停用抗心律失常药物的重复电生理检查，无一例室性心动过速发生。血流动力学和血管造影导管检查显示所有患者的血流动力学和射血分数均有改善。10名幸存者在9-20个月的时间里没有持续的室性心动过速，有1例晚期非心律失常死亡。
SUMMARYTwelve patients with medically refractory ventricular tachycardia secondary to ischemic heart disease underwent surgery for cure of their arrhythmia. Preoperatively, the tachycardia could be reproducibly initiated and terminated in each patient by programmed stimulation. In all instances, intraoperative mapping localized the tachycardia to the border of the aneurysm, a site not routinely resected during aneurysmectomy. In nine instances, the area of origin involved the septum. During bypass the tachycardia could still be induced after standard aneurysmectomy or ventriculotomy in 11 of 12 patients. On the basis of intraoperative mapping, resection of endocardium in the area of origin (25–40% the circumference of the aneurysmectomy) up to normal muscle was performed. In one patient without a discrete aneurysm, endocardial excision alone through a ventriculotomy was performed. There was one operative death due to cardiogenic shock (preoperative ejection fraction 5%) and one late death due to rupture of a mycotic aneurysm in the pulmonary artery. Before discharge, all patients underwent a repeat electrophysiologic study off antiarrhythmic agents and in none could ventricular tachycardia be initiated. Hemodynamic and angiographic catheterization showed improved hemodynamics and ejection fractions in all. The 10 survivors remained free of sustained ventricular tachycardia for 9–20 months, with one late nonarrhythmic death.