Clinical characteristics and progress in diagnosis and treatment of left ventricular aneurysm after myocardial infarction
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摘要: 左心室室壁瘤(left ventricular aneurysm,LVA)是急性心肌梗死机械并发症之一,LVA破坏心室正常结构,影响心室收缩和舒张功能,可导致反复心绞痛、恶性心律失常、心力衰竭、附壁血栓等并发症,严重影响患者预后。随着早期再灌注技术的进步和药物治疗的发展,急性心肌梗死后LVA的发生率逐渐下降。心电图是初筛心肌梗死后LVA的重要手段,但心电图表现并不特异。超声心动图是诊断LVA的常用方法,实时三维超声心动图等技术的进步提高了LVA诊断的准确性。心脏核磁相比超声心动图诊断LVA的准确性更高,延迟增强显像还可识别存活心肌。核素心室造影可准确测定左心室容量、射血分数及室壁运动,与X线左心室造影诊断LVA的符合率高。X线左心室造影是诊断LVA的金标准,但目前临床并不常用。急性心肌梗死发生后早期再灌注治疗可降低LVA发生率,多数LVA可选择内科保守治疗,抑制心室重构药物是LVA药物治疗的基础。经皮左室重建术是近年来治疗LVA的新技术,并取得了不错的效果。LVA如合并心衰、药物不能控制的恶性心律失常、血栓栓塞等并发症时可考虑外科手术治疗,细胞移植治疗是LVA切除术后有前景的治疗方式。本文就急性心肌梗死后LVA的临床特征及诊治进展做一综述。Abstract: Left ventricular aneurysm (LVA) is one of the mechanical complications of acute myocardial infarction. LVA can destroys the normal structure of the ventricle, affect ventricular systolic and diastolic function, which can lead to repeated angina, malignant arrhythmia, heart failure, left ventricular thrombus and other complications, seriously affecting the prognosis of patients. With the progress of early reperfusion technology and the development of drug therapy, the incidence of LVA after AMI gradually decreased. ECG is an important examination of screening the LVA after myocardial infarction, but the ECG is not specific. Echocardiography is a common method for the diagnosis of LVA, and the progress of real-time three-dimensional echocardiography improves the accuracy of LVA diagnosis. Cardiac magnetic resonance is more accurate than echocardiography in diagnosing LVA, and delayed enhancement cardiac magnetic resonance imaging can also identify viable myocardium. Radionuclide ventricular imaging can accurately determine the left ventricular capacity, ejection fraction and wall motion, the accuracy of diagnosis LVA is good. X-ray left ventricular angiography is the gold standard of diagnosis left ventricular aneurysm, but it is not commonly used. Early reperfusion after acute myocardial infarction can reduce the incidence of LVA. Most LVAs can choose conservative treatment of internal medicine, inhibition of ventricular remodeling drugs is the basis of LVA drug treatment. Percutaneous ventricular restoration is a new technique for the treatment of LVA in recent years and has achieved good results. When the LVA patients with complications, such as heart failure, the malignant arrhythmia cannot control by drug, thromboembolism, may be consider the surgical treatment. Cell transplantation treatment is a promising approach after treatment of resection of LVA. This review summarizes the clinical characteristics and progress in diagnosis and treatment of post-myocardial infarction left ventricular aneurysm.
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Key words:
- Myocardial infarction /
- Left ventricular aneurysm /
- Clinical characteristics /
- Diagnosis /
- Treatment
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