ABSTRACT
Objective To explore the relationship between different hemorrhage position,hemorrhage volume,surgical time and outcome of treatment with surgical methods of HICH.Methods A total of 1310 patients were admitted from six hospitals from January 2004 to January 2008,the 1310 patients were divided into six groups according to different operation:craniotomy through bone flap (group A),craniotomy through small bone window (group B),stereotactic drilling drainage (group C1 and group C2),neuron-endoscopy operation (group D) and external ventricular drainage (group E),considering hemorrhage position,hemorrhage volume,surgical time and result of surgical methods were reviewed and analyzed.Results ①Craniotomy through bone flap should be selected with the case of superficial or deep hematoma volume (＞ 80 mL),median line structure distinct motion,metaphase or advanced stage of hernia of brain.②Craniotomy through small bone window and neuron-endoscopy should be selected with the case of moderate hematoma volume (50-80 mL) ③Drilling drainage should be selected with the case of small hematoma volume in superficial or deep hematoma volume (20-50 mL) ④Extemal drainage should be selected in dealing with ventricular hemorrhage.Small bone window or neuron-endoscopy should be selected in ventricular casting mould.⑤The appropriate operation time for patients with hematoma volume less than 80 mL should be 6-12 hours and large hematoma should be immediately operated to save lives.The operation time should depend on patients detail condition.Conclusions Craniotomy through bone flap was suitable for large hematoma and hernia of brain; Stereotactic drilling drainage should be selected in patients with hematoma volume less than 80mL; and the operation results in dealing with HICH would be improved via suitable operation time and surgical methods and adividual according to Hemorrhage position and Hemorrhage volume.
ABSTRACT
Objective To evaluate the feasibility and safety of the treatment for ventricular septal rupture (VSR) by transcatheter interventional therapy coordinated with percutaneous coronary intervention (PCI) or percutaneous transluminal coronary angioplasty (PTCA).Methods Six patients who suffered from cardiogenic shock due to acute myocardial infarction (AMI) and VSR were given intra-aortic balloon pump (IABP) and mechanical ventilation support. After three weeks, they underwent transcatheter closure of ventricular septal rupture with Amplatzer ventricular septal occluder, and at the same time PCI and PTCA were performed. Results All the patients successfully underwent ventricular septal defect occlusion, including two cases of residual shunt. Segmental stenosis of the middle of anterior descending branch and circumflex artery were noted in three patients, and then stent implantation was used. The other three cases had multi-vessel lesion but were without stent implantation. All the patients with stent implantation survived and discharged. Conclusions It is safe and feasible to apply transcatheter closure of ventricular septal rupture with Amplatzer ventricular septal occluder, coordinated with PCI and PTCA for patients with acute myocardial infarction complicated with ventricular septal rupture.