心室中隔穿孔に対するDavid-Komeda変法術後に急性呼吸促迫症候群で難渋した1例

Modified David-Komeda Repair for Ventricular Septal Perforation Complicated with Severe Postoperative Acute Respiratory Distress Syndrome；Report of a Case

はじめに　急性心筋梗塞後に合併する心室中隔穿孔（VSP）の急性期手術成績は不良である．また心臓術後の急性呼吸促迫症候群（ARDS）は致命的な合併症である．発症後亜急性期にVSPに対する手術を行い，術後重症のARDSを合併したが，集中治療で救命できた症例を経験したので報告する．

A 61-year-old man presented by ambulance with dyspnea. He was diagnosed with myocardial infarction complicated with ventricular septal perforation （VSP），and intraaortic balloon pumping support and intensive care were started. Because of instability of hemodynamic status, modified David-Komeda operation with double patch was performed in the subacute phase of VSP. Although he developed acute respiratory distress syndrome （ARDS） on the 21st day after operation, he was successfully treated with corticosteroid pulse therapy and artificial ventilation. He was transferred to a rehabilitation hospital on the 141st postoperative day.