Analysis Of The Early And Mid-Term Effect Of Coronary Heart Disease With Ventricular Aneurysm After Surgical Treatment

Objective:To follow up and observe the analysis of the early and mid-term cl inical efficacy of cardiac macrovascular surgery in treating patients with ventric ular aneurysm in kunming yan’an hospitalMethods:Retrospective analysis of clinical data of 108 patients undergoing sur gical treatment of coronary heart disease with ventricular aneurysm from Januar y 2010 to May 2019.Before the operation,statistics were made by recording the general condition of the patient and the results of the transthoracic echocar diography.Intraoperative surgical treatment of patients with ventricular aneurysm Includes two types of linear repair and Endoventricular Patch Plasty.All patients were followed-up in an outpatient clinic or by a telephone interview,with a duration from 3 months to 9 years.Total follow-up duration is 115 months and 8 patients were lost to follow-up,with a follow-up rate being 92.5%.All data were analyzed with SPSS-20.Results:collected clinical data of 108 patients with coronary heart disease and ventricular aneurysm underwent surgical treatment in our hospital.there were 90 Male(83.3%)and 18 female(16.7%)patients,with an average age of 58.19±8.73 years,ranging from 35 to 74 years,and 85 cases of smoking(78.7%).23 cases(21.3%)with ventricular septal perforation,12 cases(11.1%)with mitral regurgitation,5 cases(4.6%)with tricuspid regurgitation,9 cases(8.3%)with ventricular thrombosis,and 56 cases with hypertension(51.8%),4 cases of grade 1,12 cases of grade 2,40 cases of grade 3),39 cases of diabetes(36.1%),20 cases of hyperlipidemia(18.5%),29 cases of cerebral infarction(26.9%),carotid artery 7 patients had stenosis(6.5%),8 patients had atrial fibril lation(7.4%),29 patients had previous stent implantation(26.7%),and 17 had congestive heart failure(15.7%);88 cases of angina pectoris(81.5%),91 cases of myocardial infarction(84.3%);The average cardiac function(NYHA)grade was(3.07±0.61),including 5 cases of grade Ⅱ(4.6%),87 cases of grade Ⅲ(80.6%)and 16 cases of grade Ⅳ(14.8%);18 cases(16.7%)of left main coro nary artery lesions,the average degree of stenosis(8.24 ± 21.13)%,95 cases of anteriordescending branch lesions(87.9%),the average degree of stenosis(76.89±33.67)%,the first diagonal branch lesion 24 Cases(22.2%),the aver age degree ofstenosis(17.26 ± 33.51)%,10 cases of second diagonal branch lesions(9.3%),the average degree of stenosis(7.99±25.36)%,78 cases of circumflex branch lesions(72.2%),average The degree of stenosis(55.38 ± 40.00)%,81 casesof right coronary lesions(75.0%),the average degree of steno sis(61.04±40.23)%;Ventricular aneurysms were located in 90 cases(83.3%)of apex,1 case(0.9%)of anterior wall of ventricle,4 cases(3.7%)of lateral wall,and 13 cases(12.1%)of posterior wall;Of the 108 patients with ventricul ar aneurysm,64patients received standard linear repair(59.2%)and 44 patients received left ventricular patch plasty(40.8%).At the same time,0-5 coronary artery bypass grafts(2.67 ± 1.45);A total of 12 cases(11.1%)were treated for mitral valve,including 2 cases(1.8%)for mitral valvuloplasty,9 cases(8.3%)for mechanical mitral valve replacement,and 1 case(0.9%)for biologic al valve replacement;5 cases of tricuspid annuloplasty(4.6%),including 1 case of kay’s(0.9%)and 4 cases of DeVega(3.7%);Ventricular thrombectomy was performed in 9 cases(8.3%)and ventricular septal perforation repair in 23 cases(21.3%);Average operation time(6.29 ± 1.71)h,aortic occlusion time(115.48 ± 44.39)min,extracorporeal circulation time(182.70 ± 60.09)min,ventilator time(80.55±99.82)h,ICU residence time(6.26±5.34)D,34 cases(31.5%)were assisted by IABP after operation,and the time of use of IABP(2.13 ± 4.78)d,The average diameter of the left ventricular end diastole after operation was(54.50 ± 7.41)mm,which was significantly reduced comp ared to the preoperative left ventricular end diastolic diameter(60.80±8.64)mm;The average left ventricular ejection fraction after operation was(39.22±6.36)%,which was significantlyhigher than that before operation(35.22 ±6.32)%,Differences are statistically significant(P<0.05).There were 3 cases of ventricular arrhythmia after surgery,1 case of third-degree atrioventricular block,2 cases of secondary thoracotomy exploration and hemostasis,5 cases of delayed chest closure,3 cases of delayed chest closure and delayed chest closu re again(1 death),2 cases of pericardial effusion for window drainage,3 cas es of poor wound healing,7 cases of pleural effusion,11 cases of low cardiac output syndrome(4 deaths),1 caseof severe pulmonary infection(1 death).Conclusion:Preoperative accurate stratification diagnosis of patients with coron ary heart disease complicated with ventricular aneurysm is very important,the diagnosis of patients should be hospitalized,the surgical strategy should be bas ed on the following considerations:(2)whether mitral valve replacement or mitr al valve formation should be performed simultaneously;(3)whether the tricuspid valve needs treatment;(4)the location and count of bypass transplantation.Preop erative medication was used to improve the cardiac function of patients.For patients with pump failure and difficult circulation maintenance,preoperative IA BP implantation was needed to assist in improving the perioperative survival rate and creating operative conditions.By comparing the results of color doppl er echocardiography before and after surgery,it is suggested that surgical interv ention is a relatively safe and effective method for patients with ventricular an eurysm.Both linear repair of ventricular aneurysm and ventricular patch shapin g can significantly improve the ejection fraction and left ventricular diameter o f patients.Follow-up shows that the patients are in good condition in the early and mid-term.