心室中隔穿孔に対して右室アプローチによるサンドイッチ法を施行した1例

Sandwich Technique Used with a Right Ventricular Approach for Ventricular Septal Perforation；Report of a Case

はじめに　心室中隔穿孔（VSP）は心筋梗塞後の重篤な合併症の一つである．われわれは右室切開でバイオグルー（CryoLife社，Kennesaw）とフェルトを用いて良好な結果を得た症例を経験したので報告する．

Ventricular septal perforation （VSP） leads to a high mortality rate after surgical treatment. The surgical procedure has not been established. Left ventricular （LV） incisions have mainly been performed, while we report a case of right ventricular （RV） approach that resulted in a favorable outcome in a 76-year-old male. The patient was diagnosed with myocardial infarction due to left anterior descending artery （LAD） occlusion. VSP was diagnosed after percutaneous coronary intervention （PCI） and surgery was performed on the 4th day of illness. The perforation site was identified near the anterior septum by epicardiac echography before incision, and a patch made of 3 layers using a pericardial patch, felt, and a Dacron patch was sewn on the perforation with a sandwich technique and closed with bio glue. The RV approach is a useful procedure because it avoids the hemostatic manipulation of left ventricle myocardial necrosis under high pressure and can preserve left cardiac function.