心破裂を合併した急性心筋梗塞後に仮性心室瘤が形成された1例

A Case of Left Ventricular Pseudoaneurysm Following Acute Myocardial Infarction Complicating Cardiac Rupture

　心筋梗塞後の仮性心室瘤は非常に稀な合併症であるが，今回，心破裂を合併し救命し得た急性心筋梗塞後に仮性心室瘤が形成された1例を経験したので報告する．症例は71歳，男性で，気分不良，胸部圧迫感を主訴に救急外来受診した．心電図は洞頻脈で，I，II，aV_L，aV_F，V_4〜6のST上昇を認めた．緊急冠動脈造影で左回旋枝＃13の完全閉塞を認め，direct PTCA，t-PA冠動脈内注入およびステント植え込みを行い再疎通した．その30分後に心破裂による心タンポナーデのためショックとなったが，・ドレナージおよび心筋縫合術で救命し得た．慢性期の左室造影で33mm大の瘤を認め，心エコー・MRI所見と併せて仮性心室瘤と診断した．第75病日に心室瘤切除術およびパッチ形成術を施行した．瘤壁は心筋組織を含まず，組織学的にも仮性心室瘤と診断された．

　A pseudoaneurysm following myocardial infarction is a very rare complication. We encountered a case of a left ventricular pseudoaneurysm following acute myocardial infarction complicating cardiac rupture. A 71-year-old man was admitted to our hospital because of feeling illness and chest oppression on February 8, 1998. Electrocardiogram showed sinus tachycardia and ST elevation at I , II, aV_L, aV_F, V_4~6Emergencycoronary angiogram revealed total obstruction at # 13 of the left circumflex artery. PTCA, intracoronary thrombolysis and stent implantation were performed and the lesion was reperfused. Thirty minutes later, the patient suddenly developed shock because of cardiac tamponade due to cardiac rupture, but was able to he rescued by pericardiocentesis, pericardial drainage and myocardial suture with felt. The left ventriculography during the chronic phase showed aneurysm formation with a size of 33 mm. Based on the findings of echocardiogram and MRI, it was considered to be a pseudoaneurysm. Aneurysmectomy and patchplasty were undertaken on the 75 th hospital day. Myocardial tissues were not contained in the aneurysm wall, so, pathologically, it was diagnosed as a typical pseudoaneurysm.