心室中隔穿孔に対するextended sandwich patch法施行後の遺残短絡によりinfarct exclusion法で再手術した1例

Re-operation with Infarct Exclusion Technique due to Residual Shunt after Extended Sandwich Patch Technique for Postinfarction Ventricular Septal Perforation：Report of a Case

はじめに　急性心筋梗塞（AMI）後心室中隔穿孔（VSP）に対してextended sandwich patch法を施行後に遺残短絡が増大し，infarct exclusion法で再手術を施行した症例を経験したので，文献的考察を加え報告する．

We report a case in which infarct exclusion technique was used to repair residual shunt after extended sandwich patch technique for postinfarction ventricular septal perforation （VSP）. A 76-year-old woman was diagnosed with postinfarction VSP and underwent extended sandwich patch technique through right ventriculotomy on the third day after the onset of VSP. No residual shunt was then observed by intraoperative transesophageal echocardiography, but a slight residual shunt was observed on the 7th day after operation. She had no symptom of cardiac failure, and was followed up. However, the residual shunt worsened, and she developed cardiac failure on the 48th day after the initial operation. An additional operation by infarct exclusion technique was performed. No residual shunt was observed after the additional operation. She has been doing well with no signs of cardiac failure.