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.
目的總結分析經左胸微創冠狀動脈旁路移植術（MIDCAB）與經皮冠狀動脈介入治療（PCI）聯合應用治療冠狀動脈多支血管病變的初步臨床經驗。 方法回顧性分析鄭州市第七人民醫院2013年1月至2014年11月共16例多支冠狀動脈病變冠心病患者的臨床資料，其中男10例、女6例，年齡46～73（58.4±9.7）歲，采用“分站式”復合技術（Hybrid）進行心肌再血管化。 結果16例患者手術均順利完成，無圍手術期死亡，PCI時行冠狀動脈造影提示冠狀動脈吻合口通暢，隨訪3～22（14.0±8.6）個月，臨床癥狀緩解，恢復正常工作及生活。 結論“分站式”復合技術治療冠狀動脈多支血管病變近期效果滿意，長期效果有待進一步隨訪。