Analysis Of The Therapeutic Effect Of Early Elective Surgery For Ventricular Septal Perforation After Acute Myocardial Infarction

Objective: The purpose of this study was to explore the clinical efficacy of early routine surgery(interval ventricular septal perforation to operative time 3 to 4 weeks)in patients with ventricular septal perforation after acute myocardial infarction.Aims and Methods: 32 patients who underwent repair of interventricular septum perforation in the first affiliated Hospital of Zhengzhou University from June 2011 to January 2019 were selected(the time from perforation of interventricular septum to operation was 3 to 9 weeks).According to the time from perforation of interventricular septum to operation,the patients were divided into early group(the time from perforation of interventricular septum to operation was 3 to 4 weeks)and non-early group(the time from perforation of interventricular septum to operation was ?5 weeks).The clinical data of the two groups were recorded before,during and after operation.Comparison of the two groups of patients:(1)basic clinical data,(2)operation time,cardiopulmonary bypass time,aortic cross-clamping time,intraoperative blood loss and intraoperative red cell volume;(3)the duration of ventilator-assisted respiration and intensive care after operation.Long,postoperative drainage,short-term(30 days)postoperative complications(residual ventricular septum leakage,recurrent interventricular septum perforation,new ventricular arrhythmias,renal failure,moderate pericardial and pleural effusion)and death within 30 days after operation.Condition;(4)preoperative and last follow-up cardiac ultrasound indexes,such as left ventricular ejection fraction,pulmonary artery pressure and left ventricular end-diastolic diameter;(5)preoperative and last follow-up cardiac ultrasound indexes,such as left ventricular ejection fraction,in both groups.(4)preoperative and last follow-up cardiac ultrasound indexes in the two groups,such as left ventricular ejection fraction,pulmonary artery pressure and left ventricular end-diastolic diameter.Number,pulmonary artery pressure and left ventricular end diastolic diameter;(6)survival rate and adverse events(death,recurrent perforation,heart failure,recurrent myocardial infarction)during follow-up.Result: The levels of troponin T and brain natriuretic peptide in the early group were significantly higher than those in the non-early group(P < 0.05),but there was no significant difference in the other basic data(P > 0.05).There were significant differences in operation time,cardiopulmonary bypass time,aortic clamping time and intraoperative blood loss between the two groups(P < 0.05).There was no significant difference in the amount of intraoperative red blood cells and the number of patients with IABP during operation(P > 0 05).In the early group,4 cases died,1 case died of malignant arrhythmia after operation,1 case died of severe low cardiac output after operation,1 case died of postoperative second thoracotomy to stop bleeding,and then renal failure and pulmonary infection occurred.ECMO was used to assist.The patient's family gave up treatment.One case had residual leakage in VSR,about 3.5mm,and repeated heart failure after operation.The effect of IABP was still poor,resulting in the death of cardiogenic shock.In the non-early group,3 cases died,1 case had ventricular fibrillation when preparing to close the chest during operation,temporary administration of IABP,acute renal failure after operation,CRRT,died of multiple organ failure,and 2 cases died of low cardiac output syndrome after operation.There was no significant difference in death between the two groups(P > 0.05).There was significant difference in postoperative drainage between the two groups(P < 0.05).In ventilator-assisted breathing time,intensive care duration,postoperative hospital stay,postoperative short-term(within 30 days)complications(residual interventricular septum leakage,recurrent interventricular septum puncture).There was no significant difference in foramen,new ventricular arrhythmias,cerebral infarction,renal failure,moderate pericardium and pleural effusion(P > 0.05).There was no significant difference in left ventricular ejection fraction and left ventricular end diastolic diameter of pulmonary artery pressure between the two groups(P > 0.05).However,there were significant differences in cardiac ultrasound indexes between the two groups before and after the last follow-up(P < 0.05).There was no significant difference in adverse events(death,recurrent perforation,heart failure,recurrent myocardial infarction)between the two groups(P > 0.05).Conclusion: 1.In the early stage(within 3 to 4 weeks),the short-and medium-term effect of surgical treatment of ventricular septum perforation after acute myocardial infarction can be achieved,and the cardiac function of the patients is significantly improved after operation,but it still needs to be further confirmed by long-term follow-up.2.Patients with ventricular septum perforation after acute myocardial infarction still need individualized treatment,such as circulatory and respiratory stability,early surgical treatment(within 3 to 4 weeks)may be considered.If hemodynamics is unstable,emergency surgery is still needed.