左室瘤と心室中隔穿孔を合併した亜急性下壁心筋梗塞に対する経右室パッチ閉鎖術

Patch Closure of Posterior Type Ventricular Septal Perforation with Posterior Left Ventricular Aneurysm through Right Ventricular Incision

心室中隔穿孔（VSP）に対する手術成績はいまだ不良で，そのアプローチ法は重要な課題の一つである．右室切開アプローチは術後右心不全の欠点があるものの，左室機能の温存および止血に対する利点があり，特に後壁型VSPに有用とされる1）．われわれは下壁心筋梗塞の亜急性期に左室瘤を合併した高位後壁VSPに対して右室切開アプローチによるパッチ閉鎖を行い，良好な結果を得たので報告する．

We report a case of patch closure of posterior type ventricular septal perforation （VSP） with posterior left ventricular aneurysm （PLVAN） through right ventricular incision. A 70-year-old man was transferred to our hospital because of persistent epigastric pain. He was diagnosed with inferior acute myocardial infarction, and percutaneous coronary intervention was performed to the right coronary artery ［atrio-ventricular （AV）］. After 2 weeks, he developed congestive heart failure and was treated with inotropic support and intra-aortic balloon pumping. Echocardiography and computed tomography （CT）showed posterior type VSP between PLVAN and the right ventricle. The operation was performed via standard median sternotomy and under cardiopulmonary bypass. After right ventricle incision parallel to the left anterior descending artery, there was VSP （20×20 mm） behind the trabecular septmarginalis （TSM）. We closed VSP with a 2-layer patch （40×40 mm） consisted of Dacron and bovine pericardial patches. Postoperative echocardiography showed no residual shunt, and postoperative CT showed no enlargement of PLVAN. He was discharged home on foot without right heart failure and has been well without major complications.