Objective To investigate the effect and prognosis of patients with ventricular septal rupture after myocardial infarction treated by surgical repair combining an occluder and a patch. Methods Clinical data of 42 patients with myocardial infarction complicated with ventricular septal rupture admitted to the First Affiliated Hospital of Zhengzhou University from January 2010 to September 2021 were retrospectively analyzed. According to the surgical methods, 27 patients were divided into a traditional group, including 17 males and 10 females, with an average age of 62.81±6.81 years, who were repaired by patch only, and 15 patients were divided into a modified group, including 11 males and 4 females, with an average age of 64.27±9.24 years, who were repaired by surgery combining an occluder and a patch. Perioperative and follow-up data of the two groups were compared and analyzed.Results There were statistical differences between the two groups in preoperative Killip grading, rate of intra-aortic balloon pump use, interval from myocardial infarction to operation, and the number of culprit artery (P<0.05). There was no statistical difference in other preoperative data, the cardiopulmonary bypass time, aortic cross-clamping time, postoperative hospital stay or in-hospital death rate between the two groups (P＞0.05). No residual shunt occurred in the modified group, and the difference was statistically significant compared with the traditional group (P=0.038). There was no statistical difference in other complications between the two groups (P＞0.05). The median follow-up time was 4 years. Two patients in the traditional group and one in the modified group died during follow-up. The follow-up cardiac function grading of patients in the modified group was statistically different from that in the traditional group (P=0.023). Conclusion The perioperative mortality of ventricular septal rupture after myocardial infarction is high, but the long-term effect is satisfactory. Surgical repair combining an occluder and a patch is a safe and effective treatment for ventricular septal rupture, which can effectively reduce postoperative residual shunt.
目的总结分析经左胸微创冠状动脉旁路移植术（MIDCAB）与经皮冠状动脉介入治疗（PCI）联合应用治疗冠状动脉多支血管病变的初步临床经验。 方法回顾性分析郑州市第七人民医院2013年1月至2014年11月共16例多支冠状动脉病变冠心病患者的临床资料，其中男10例、女6例，年龄46～73（58.4±9.7）岁，采用“分站式”复合技术（Hybrid）进行心肌再血管化。 结果16例患者手术均顺利完成，无围手术期死亡，PCI时行冠状动脉造影提示冠状动脉吻合口通畅，随访3～22（14.0±8.6）个月，临床症状缓解，恢复正常工作及生活。 结论“分站式”复合技术治疗冠状动脉多支血管病变近期效果满意，长期效果有待进一步随访。