下壁梗塞後の心室中隔穿孔に対するinfarct exclusion変法および僧帽弁置換術

Infarct Exclusion Repair and Mitral Valve Replacement for Inferior Postinfarction Ventricular Septal Perforation

心室中隔穿孔（VSP）は致死率の高い急性心筋梗塞（AMI）合併症である．われわれは，基部心室中隔にVSPを生じ，乳頭筋の梗塞が顕著であったため，僧帽弁置換術（MVR）とともにVSPをinfarct exclusion法で閉鎖することにより，救命しえた症例を経験したので報告する．

We performed infarct exclusion repair of ventricular septal perforation （VSP） in a 63-year-old woman who was diagnosed with acute myocardial infarction （AMI） of the inferior wall. As VSP existed behind a fragile posterior papillary muscle, we excised the papillary muscle and sutured a bovine pericardial patch to exclude the infarct area of the whole septum and a part of the inferior wall. Mitral valve replacement and coronary artery bypass were also performed. The postoperative course was uneventful. There was no residual shunt and the left ventricular function was preserved. Selection of surgical procedures taking account of complete closure of VSP is important.