下壁梗塞に合併した心室中隔穿孔に対する右室アプローチサンドイッチ法の1例

Postinfarction Ventricular Septal Perforation Treated with the Sandwich Method Using a Right Ventricular Approach；Report of a Case

はじめに　心室中隔穿孔（VSP）は，急性心筋梗塞（AMI）に発症する非常にまれで重篤な合併症で，予後不良である．われわれは下壁梗塞に合併したVSPに対し，右室切開によるサンドイッチ法により良好な結果を得たため報告する．

The patient was a 75-year-old man who presented to our hospital with complaints of palpitation and a cold sensation. Echocardiography revealed ventricular septal perforation （VSP） at the base of the posterior septum. As his hemodynamic condition was stable, patch closure of the VSP was performed on the 50th hospital day after fibrosis at the infarction site developed. Under cardiac arrest, an incision directed toward the cardiac apex was made at the base of the right ventricular inferior wall. Closure of the VSP was performed using double-patch sandwich technique：a bovine pericardial patch on the left, and a Dacron patch on the right ventricular side. The postoperative course was uneventful.