PCPS下にSutureless Patch Repairを行い救命しえた心筋梗塞後左室自由壁破裂の1例

A Case of Sutureless Patch Repair for Postinfarction Left Ventricular Free Wall Rupture under PCPS

要旨

　患者は74歳，男性．1カ月前からの胸痛と一時的意識消失を主訴に救急受診となった．心筋梗塞後左室自由壁破裂(oozing型)が疑われ，直ちにIABPを挿入した．入院後11日にIABPを抜去したが，血行動態が不安定になり再挿入し緊急手術を行うこととなった．血行動態が不安定であったため，麻酔導入前にPCPSを大腿動静脈から確立し循環補助を行った後に導入した．左第4肋間開胸で手術を開始，心膜を切開すると後側壁に凝血塊があった．血液成分を取り除き，Gelatin Resorcin Formaldehyde^(R)lueを塗布し牛膜シートで覆い圧迫，さらにその周囲にフィブリン糊を塗布した．PCPSからの離脱を試みたが，血行動態を保つことができず補助循環下にICUへ入室，術後1日にPCPSを離脱，術後9日にIABPを抜去することができた．sutureless patch repairは梗塞部切除などによる左室容量減少を回避し，さらに心停止をしないで行える有用な方法であると思われる．

Summary

We present a case of sutureless patch repair for postinfarction left ventricular free wall rupture using PCPS. A 74 years old man was admitted in our hospital with chest pain and temporary faintness. His diagnosis was postinfarction left ventricular free wall rupture(oozing type)of posterolateral wall based on ECG findings and free space in echocardiography, so the IABP was immediately used for to reduce afterload of left ventricular. Eleven days after administration, his hemodynamics deterorated, and the emergent operation was decided. PCPS was established before general anesthesia and the operation was performed through left thoracotomy of the 4th intercostal space. The infarction area was reinforced with Gelatin Resorcin Formaldehyde^(R)glue and covered with bovine pericardial patch. We suggest that this method is effective without left ventricular volume reduction and bleeding of infarctectomy.