2026 年第 3 期 第 21 卷

急性心肌梗死后室间隔穿孔的诊疗研究进展

Research progress on diagnosis and treatment of ventricular septal rupture after acute myocardial infarction

作者：程思昊刘楠

英文作者：Cheng Sihao Liu Nan

单位：首都医科大学附属北京安贞医院心脏外科危重症中心一区，北京101118

英文单位：Center for Cardiac Intensive Care of Surgery Zone 1 Beijing Anzhen Hospital Capital Medical University Beijing 101118 China

关键词：急性心肌梗死后室间隔穿孔；机械循环支持；经导管封堵；外科修补；手术时机；预后因素

英文关键词：Post-infarctionventricularseptalrupture;Mechanicalcirculatorysupport;Transcatheterclosure;Surgicalrepair;Timingofsurgery;Prognosticfactors

• 摘要：

• 急性心肌梗死后室间隔穿孔（PIVSR）是急性心肌梗死（AMI）一种罕见但致命的机械并发症。再灌注时代其发病率降至1%以下，但一旦发生，死亡率仍极高（40%～90%）。其病理生理核心是透壁性梗死区破裂导致左向右分流，引发急剧的血流动力学恶化。临床表现多为AMI后病情突然加重，伴新发心脏杂音，床旁超声心动图为首选诊断方法 。治疗需多学科协作，个体化选择药物、机械循环支持（如主动脉内球囊反搏、体外膜氧合），最终以外科手术修补或经导管介入封堵作为决定性手段。手术时机选择存在争议，需权衡血流动力学稳定与组织纤维化程度。预后极差，受高龄、心源性休克、穿孔位置及手术时机等多种因素影响。本文总结讨论PIVSR的流行病学、病理生理、诊疗及预后，以指导临床实践。

• Post-infarction ventricular septal rupture (PIVSR) is a rare but fatal mechanical complication of acute myocardial infarction (AMI). In the reperfusion era, its incidence has decreased to below 1%, yet once it occurs, the mortality rate remains extremely high (ranging from 40% to 90%). The core pathophysiology is the rupture of the transmural infarct zone, leading to left-to-right shunt and rapid hemodynamic deterioration. The clinical manifestation is mostly sudden exacerbation of the condition after AMI, accompanied by a new-onset cardiac murmur, and bedside echocardiography is the preferred diagnostic method. Treatment requires multidisciplinary collaboration, with individualized selection of medications, mechanical circulatory support (such as intra-aortic balloon pump, extracorporeal membrane oxygenation), and ultimately surgical repair or transcatheter closure as the definitive treatments. The timing of surgery is controversial and requires balancing hemodynamic stability and the degree of tissue fibrosis. The prognosis is extremely poor, affected by multiple factors such as advanced age, cardiogenic shock, rupture location and surgical timing. This paper summarizes and discusses the epidemiology, pathophysiology, diagnosis, treatment and prognosis of PIVSR to guide clinical practice.