心筋梗塞後の左室仮性瘤切除術の10年後に発生した感染性心内膜炎による左室仮性瘤の1例

Pseudoaneurysm with Infective Endocarditis Ten Years After the Resection of Pseudoaneurysm Complicated with Myocardial Infarction；Report of a Case

はじめに　急性心筋梗塞（AMI）後の合併症である左室破裂は予後不良で，急性期を乗り切っても後に仮性心室瘤を形成するとされている．われわれは，3枝病変のAMIに伴う左室仮性瘤に対して冠状動脈バイパス術（CABG）と左室瘤切除術を行った10年後に，感染性心内膜炎（IE）を発症して左室仮性瘤を形成したため，左室瘤切除術を施行した1例を経験したので報告する．

A 76-year-old female was referred to our hospital for fever and chillness. She was diagnosed with pneumonia and sepsis, and methicillin-resistant Staphylococcus aureus （MRSA）was detected by the sputum culture. Echocardiography showed mobile vegetation and left ventricular pseudoaneurysm at the apex. As she had a history of ventricular pseudoaneurysmectomy 10 years before, we considered the patient had developed infective endocarditis at the surgical site. Surgical treatment was needed because of the rapidly growing pseudoaneurysm despite the use of antibacterial agents.

She successfully underwent resection of the pseudoaneurysm and MRSA was also detected in the culture of the previous vascular graft patch. Antibacterial agents were administrated for 6 weeks, and she was discharged at 53 days after operation.