ウレタンプレポリマー止血剤が奏効したsutureless法による急性心筋梗塞後blow-out型左室自由壁破裂

Successful Repair of a Blow-out Type Left Ventricular Free Wall Rupture after Acute Myocardial Infarction Using a Viscous Diisocyanate Prepolymer

急性心筋梗塞後の虚血性心破裂は致死率の高い合併症であり1），特にblow-out型の場合，循環虚脱までの時間が短く救命がさらに困難であり，手術後の死亡率も15～51.9％と高率である2，3）．われわれは急性心筋梗塞後のblow-out型左室自由壁破裂に対して，ポリエーテル系含フッ素ウレタンプレポリマーからなる止血剤［以下Hydrofit（三洋化成工業社，京都）］を使用し，ウシ血清アルブミンとグルタルアルデヒドの架橋反応を利用する接着剤［以下BioGlue（CryoLife社，Kennesaw）］，フィブリン糊付着コラーゲンスポンジシート［以下TachoSil（CSL Behring社，King of Prussia）］をさらに重層するsutureless法で救命した1例を経験したので，文献的考察を加えて報告する．

We report our experience with blow-out type left ventricular free wall rupture after acute myocardial infarction, treated by a sutureless technique using Hydrofit （a viscous diisocyanate prepolymer）. A 70-year-old woman suddenly experienced cardiopulmonary arrest during gastrointestinal endoscopic examination. Computed tomography revealed cardiac tamponade, loss of contrast in the posterolateral wall of the left ventricle and contrast medium leakage into the pericardial cavity from the lateral wall of the left ventricle. Under cardiopulmonary resuscitation, the patient was transferred to our hospital. Percutaneous cardiopulmonary support was initiated in the operating room, and median sternotomy was immediately performed. The myocardial tear and necrotic area were sealed with Hydrofit and further covered with BioGlue and TachoSil under cardioplegic heart arrest. Hemostasis was completely achieved, and cardiopulmonary bypass （CPB） was discontinued under intraaortic balloon pumping （IABP） support. At 5 years after surgery, echocardiography showed no pseudoaneurysm formation. This sutureless repair technique using Hydrofit may be useful for a selected case of blow-out type left ventricular free wall rupture.