内視鏡を併用した左室仮性瘤修復術

Video Assisted Left Ventricular Pseudoaneurysm Repair

左室仮性瘤はまれな心筋梗塞後合併症であるが，いわゆる心筋梗塞後心室瘤との鑑別を行い，早期外科的介入をすみやかに判断しなければならないとされている．MDCT検査で診断にいたり，二重パッチとフィブリングルーを用いて良好な左室腔形態を保ちつつ，術中内視鏡検査で乳頭筋を確認することで僧帽弁機能を温存しながら，左室仮性瘤切除を行うことができた症例を経験した．

An 80-year-old male was admitted to our hospital because of subacute myocardial infarction with moderate mitral regurgitation. Though he recovered well and went home within 2 weeks, the transthoracic echocardiography revealed rapid growing aneurysmal changes at the left ventricular posterior wall. We made diagnose of a pseudoaneurysm by the multi detector-row computed tomography, and planed a surgical treatment. Following the cardiac arrest, an endoscope was inserted into the left ventricle, we inspected the relation between the mitral valve and papillary muscles to detect proper suture lines and to avoid the mitral regurgitation. The defect of the left ventricular wall was repaired with 2-layer bovine pericardial patches reinforced with fibrin glue. His postoperative course was uneventful, and he was discharged from hospital on 12th postoperative day. We consider that inspections of intra-ventricle apparatus with the endoscope are useful to prevent the mitral valve insufficiency and keep the optimal left ventricle shape.