気管支喘息を合併した高齢者心筋梗塞後心室中隔穿孔の手術治験例

Surgical treatment of ventricular septal rupture following myocardial infarction in an aged patient with bronchial asthma

　急性心筋梗塞に伴う心室中隔穿孔の内科的治療の予後は極めて重篤で，外科的治療によって，初めて救命が可能となる場合が多い。特に以前は死亡率の高かった急性期手術の成績が向上したことにより，最近では積極的に早期手術を考える傾向にあり，また，高齢者に対する手術適応も拡大されてきた。

　今回我々は気管支喘息を合併した75歳の心室中隔穿孔の症例を経験し，急性期に緊急手術を施行して良好な結果を得たので若干の文献的考察を加えて報告する。

Urgent surgery for ventricular septal rupture fol-lowing myocardial infarction in a 75-year-old female with bronchial asthma was successfully perfor-med. On Feb 28, 1988, she had chest pain, and was admitted 5 days later because of the appearan-ce of heart murmur. Pansytolic murmur (Levine 4/VI) on 3 LSB and piping sound on both lung fields was heard, ECG showed acute anteroseptal infarction. Right heart Swan-Ganz catheterization revealed left to right shunt, and the diagnosis was ventricular septal rupture following acute antero-septal infarction with bronchial asthma. The initial hemodynamic condition was not serious, but soon after the diagnosis was confirmed, IABP was in-serted and operation was indicated because of the advanced age, high shunt ratio (70%) and compli-cation of bronchial asthma. The operation was per-formed a day after septal rupture. The perforationin the ventricular septum of the apex was sutured with a xenopericardium patch by mattres sutures through a left ventricle approach, and the ventri-cular wall was closed with this patch together. Thepostoperative course was uneventful, and the patient was discharged on the 43rd day after the opera-tion.