心筋梗塞後の後方型心室中隔穿孔に対する経右室拡大サンドイッチ法

Extended Sandwich Patch Repair with the Right Ventricular Approach for Posterior Ventricular Septal Perforation

下壁急性心筋梗塞（下壁AMI）後の後方型心室中隔穿孔（後方型VSP）に対し，経右室的に拡大サンドイッチ法による修復術を行って救命した症例を経験した．VSP部位と右房・右室アプローチに関して若干の文献的考察を加えて報告する．

Ventricular septal perforation （VSP） is a catastrophic complication of acute myocardial infarction, and posterior VSP reportedly has worse outcomes. We present a case of a 79-year-old man with posterior VSP following acute myocardial infarction. He underwent percutaneous coronary intervention for acute postero-inferior myocardial infarction due to occlusion of the mid-portion of the right coronary artery. Ultrasound Cardiography （UCG） revealed the VSP on the posterior ventricular septum with right ventricle （RV） inferior wall akinesis. Surgical repair was planned 4 weeks later because his hemodynamic state remained stable without intraaortic balloon pumping （IABP） support. Post-infarction posterior VSP was successfully repaired through inferior right ventricular incision. Two patches were fixed to the ventricular septum using the sandwich patch technique with BioGlue surgical adhesive reinforcement. The postoperative course was uneventful, and there was no residual shunt after the operation. This method of approaching via right ventricular incision was considered to be useful in patients who have severe necrosis near the free-wall side of the posterior VSP.