| 赵映,何怡华,刘文旭,孙琳,韩建成,温兆赢.急性心肌梗死后心肌夹层的超声心动图特点及临床转归[J].中国医学影像技术,2015,31(7):1011~1014 |
| 急性心肌梗死后心肌夹层的超声心动图特点及临床转归 |
| Echocardiographic features and clinical outcome of myocardial dissection after acute myocardial infarction |
| 投稿时间：2014-10-13 修订日期：2014-12-02 |
| DOI：10.13929/j.1003-3289.2015.07.012 |
| 中文关键词: 超声心动描记术 心肌梗死 心肌 夹层 |
| 英文关键词:Echocardiography Myocardial infarction Myocardium Dissection |
| 基金项目:国家自然科学基金(81200166、81401375) |
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| 中文摘要: |
| 目的 观察急性心肌梗死后并发心肌夹层的超声心动图特点及临床转归。方法 回顾性分析5例急性心肌梗死后并发心肌夹层患者的超声心动图表现及临床转归。结果 5例心肌夹层病例中,2例为前间隔心肌梗死,心肌夹层部位为左心室心尖部至室间隔中下段,并破入右心室,2例患者均接受积极外科手术修复后出院;2例为下壁、后壁心肌梗死,并发左心室下壁心肌夹层,在随访过程中,夹层逐渐缩小,有自愈倾向,故未行针对性治疗;1例为下壁、右心室心肌梗死,合并后间隔心肌穿孔及右心室下壁心肌夹层,并伴有三尖瓣腱索断裂,因病情严重,并发肾功能不全,患者未及时接受外科治疗而死亡。结论 心肌夹层为急性心肌梗死的罕见并发症,夹层发生部位与心肌梗死位置相关,部分患者有自愈倾向;若合并室间隔穿孔,病情严重,需积极行外科手术治疗。超声心动图为其重要的影像学检查方法。 |
| 英文摘要: |
| Objective To observe the echocardiographic features and clinical outcome of myocardial dissection after acute myocardial infarction (AMI). Methods The echocardiographic features of 5 patients with myocardial dissection after AMI were reviewed, and the clinical outcome was followed up. Results In the 5 cases, 2 of them were anterior septal myocardial infarction, the myocardial dissections were from the left ventricular (LV) apex to interventricular septum, who were surgically repaired, another 2 cases were inferior and posterior LV myocardial infarction, and the myocardial dissections located LV inferior wall, who were not managed surgically because of the regression of the myocardial dissection during follow-up, the last one patient was LV inferior and right ventricular (RV) myocardial infarction, the myocardial dissection located the RV inferior wall, who complicated with postero-septal ventricular rupture, tricuspid chordate rupture and renal dysfunction at the same time. The surgical repair was not performed because of deteriorated cardiac and renal function, and patient died 22 days later. Conclusion Myocardial dissection is a rare complication after AMI, the location is related to the position of AMI. Some cases can spontaneous resolution during follow up and are unnecessary to be repaired, but the surgical repair is necessary if one complicates with ventricular septal rupture and other emergency conditions. Echocardiography is the most important imaging facility for myocardial dissection. |
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