左室瘤に対するendoventricular stepwise plication

Endoventricular Stepwise Plication for Left Ventricular Aneurysm

左室瘤に対してDor手術1），septal anterior ventricular exclusion（SAVE）手術2）やoverlapping法3）などが開発され，左室減容術から発展し，左室形態や機能面を考慮した術式が試みられている．Hiraokaらも左室容量および形態の再建を目的としたendoventricular spiral plication（ESP）を報告している4）．われわれは，パッチを用いずに心尖部左室瘤を3段に縫縮する左室形成術（endoventricular stepwise plication）を施行したので報告する．

A 69-year-old man was treated with oral anticoagulation for the left ventricular （LV） aneurysm. Echocardiography revealed dyskinetic apex with a mobile thrombus. The estimated LV end-diastolic and end-systolic volume index （LVEDVI, LVESVI） was 76 and 44 ml/m2, respectively. After the LV was opened at the apex parallel to the left anterior descending artery, removal of LV thrombus was performed. LV volume was 70 ml, and diameter of LV aneurysm was 3 cm. After setting a neo-apex, the boundary between the normal and aneurysmal scar tissue were doubly encircled by a pledgeted 2-0 polypropylene suture, and preserved the same diameter as the “aneurysmal neck” （3 cm） in order to secure the minimal residual LV volume. Similarly, second and third circular stitches were placed toward the neo-apex to make the ventricle into an elliptical shape. A postoperative echocardiography showed a well-reconstructed physiologic shape, LV volume （LVEDVI 62 ml/m2, LVESVI 27 ml/m2）, and improved LV function.