梗死后室间隔缺损的活体形态学及其对封堵的意义
The In Vivo Morphology of Post-Infarct Ventricular Septal Defect and the Implications for Closure
梗死后室间隔缺损（PIVSD）是急性心肌梗死的灾难性并发症。本研究回顾性分析32例PIVSD的CT或磁共振影像，首次详细描述活体患者的解剖特征。缺损大（平均最大径26.5毫米）、呈椭圆形、边缘薄，仅22%完全局限于室间隔，缺损在收缩期或舒张期大小可不同。最大的Amplatzer封堵器仅能填充50%的缺损。结论认为单相测量不适用，现有封堵器常不适用，成功封堵可延长生存，研究有助于改进患者筛选、封堵技术和器械设计。
为什么推荐给您：首次在活体系统描述PIVSD动态解剖，为器械改进提供新认识，值得关注。
不需要生物学背景，多打比方
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摘要Abstract
OBJECTIVES: The aim of this study was to define the dynamic in vivo morphology of post-infarct ventricular septal defect (PIVSD), which has not been previously described in living patients.
BACKGROUND: PIVSD is a devastating complication of acute myocardial infarction.
METHODS: The anatomic features of PIVSD, as demonstrated by computed tomography or magnetic resonance imaging, were retrospectively reviewed.
RESULTS: Thirty-two PIVSDs were assessed, 16 left coronary artery and 16 right coronary artery PIVSDs. PIVSDs were large (mean maximum dimension 26.5 ± 11.5 mm, mean area 5.2 ± 4.2 cm2) and oval (mean eccentricity index 1.7 ± 0.5), with thin margins (diastolic mean thickness 5 mm from the edge of the PIVSD 6.4 ± 3.0mm), and only 22% of PIVSDs were entirely confined to the septum. The defects could be larger in diastole or systole. The stem of the largest available Amplatzer occluder stem (St. Jude Medical, St. Paul, Minnesota) filled only 50% of defects. Patients with small defects may survive without closure. Without closure, those with large defects die. If accepted for closure, PIVSD size and coronary territory did not predict survival >1 year (overall 60%).
CONCLUSIONS: This is the first detailed anatomic description of PIVSD in living patients. Defects may be larger in systole or diastole, meaning that single-phase measurement is unsuitable. Its complex nature means that the most commonly available occluder device is frequently unsuitable. Successful closure leads to prolonged survival and should be attempted where possible. This study may lead to improved patient selection, closure techniques, and device design.