aneurysm resection

Cooley recently pointed out that he had undergone 35 years of ventricular aneurysm resection under the first direct vision, and improved the ventricular aneurysm resection procedure after repairing ventricular aneurysm of about 2,500, which was an internal suture and repair. The method is the same as that of Jatene and Dor (ie, to restore the left ventricular geometry and function). In technical operation, Cooley advocates covering the remaining tumor wall on the patch, which is beneficial for hemostasis and reinforcement repair. Treatment of diseases: congestive heart failure myocardial infarction complicated with left ventricular aneurysm Indication Indication Symptoms of ventricular aneurysm should be treated promptly, and asymptomatic ventricular aneurysm does not require surgery. The indications for surgery are: 1. Angina: It is the most common indication for excision of an aneurysm. After the aneurysm is removed, the volume of the heart chamber is reduced, so the wall tension and oxygen need to be reduced, and the angina is relieved. 2. Congestive heart failure: Excision of ventricular aneurysm without contraction and abnormal pulsation can reduce the volume of the heart chamber and the end-diastolic pressure, improve the contraction effect of the remaining myocardium, thereby improving the heart's work. 3. Repeated ventricular arrhythmias: surgery is an important option for this type of surgery. Especially after the clinical application of electrophysiological mapping technology, the number of surgical treatment cases is increasing. 4. Systemic embolism: Although 50% of cases of ventricular aneurysm have thrombosis, the rate of systemic embolism is not high, but it is still an indication for surgical treatment. If infective endocarditis occurs in the wall thrombus, the surgery is removed. The source of this type of sepsis should be more positive. 5. Pseudo-ventricular aneurysm, the chance of rupture is large, and surgical resection must be considered as soon as possible. The aneurysm surgery is best performed 3 months after myocardial infarction because the surgical mortality rate is higher within 3 months. In addition, myocardial function improvement of the ischemic wall and infarct myocardial scar formation can be allowed during the waiting process. Scars can help determine the ventricular aneurysm boundary and provide better repair suture conditions. However, in many cases, ventricular aneurysm surgery is often forced to occur within 3 months after myocardial infarction, and mortality is acceptable. Approximately 1/4 of the cases can be treated with simple ventricular aneurysm, and the remaining 3/4 of the cases often require simultaneous revascularization of the heart muscle. Apical ventricular aneurysm, coronary angiography often see anterior descending branch straightening, narrow lumen, few branches, especially when such blood vessels have interval branches, it is valuable to do bypass grafting in this area at the same time. It can guarantee the blood supply of the interventricular septum and improve its function. Contraindications The choice of surgical cases should be based not only on the patient's symptoms, but also on the findings of cardiovascular angiography and cardiac function status. Surgery should not be performed in the following cases: 1. The ventricular aneurysm occupies more than 50% of the free wall of the left ventricle, and there is too little myocardial remaining after contraction. 2. Chronic ventricular aneurysm is associated with extensive myocardial lesions, and the heart is clearly spherical. 3. Functional ventricular aneurysm, whether dyskinetic aneurysm or akinetic aneurysm, is generally not suitable for surgical resection. Such functional ventricular aneurysm or wall motion disorder is sometimes difficult to determine from left ventricular angiography alone. Mangschau proposed the use of radionuclides for left ventricular myocardial imaging for differentiation. About half of patients with left ventricular aneurysm resection have coronary artery left anterior descending stenosis, and another reported 2/3 with multivessel disease, including 98% of left anterior descending artery, 83% complete lumen Occlusion; the right crown and the circumflex branch or branch affected each accounted for about 75%. Therefore, it is suggested that the surgical preparation of coronary artery bypass grafting must be performed at the same time when the aneurysm is removed. Preoperative preparation 1. Eliminate all infected lesions. 2. Correct malnutrition, anemia, and liver, kidney, and other organ dysfunction. 3. Correct heart failure or put the patient in the best possible condition. 4. Stop the digitalis and diuretics 48 hours before surgery. 5. Use an ordinary diet 1 week before surgery to adjust the electrolyte balance. If the patient takes long-term diuretics, the oral potassium chloride should be increased in the first week before surgery to overcome the deficiency of potassium in the body. 6. Start antibiotics with antibiotics on the 3rd day before surgery. Give a dose of antibiotics when you use the medicine before surgery. 7. In severe cases, glucose, insulin and potassium chloride solution (gik) were intravenously administered 1 week before surgery to protect the myocardium. 8. Psychotherapy should be performed on patients before surgery to eliminate concerns and enhance cooperation between doctors and patients. Let the patient understand the various situations that may occur during the operation to facilitate the patient's active cooperation. Try to improve heart function and increase cardiac reserve before surgery. Surgical procedure 1. Incision: The median incision of the sternum. 2. Heart table exploration to determine the location and size of the ventricular aneurysm. 3. Establish extracorporeal circulation. 4. Excision of ventricular aneurysm: a longitudinal incision is made in the ventricular aneurysm, and the finger is probed to determine the extent of the resection. 5. Expand the incision and remove the blood clot. 6. Excision of the ventricular aneurysm and cutting of the scar tissue. 7. Two polyester gaskets are placed on both sides of the ventricular incision, and a row of intermittent sutures is sutured, followed by a row of continuous suture reinforcement. 8. The lower end of the heart incision temporarily leaves the exhaust pipe, and the heart is pulled out after jumping.