2．心室中隔穿孔

Emergency Surgery for Post Infarction Ventricular Septal Perforation

日本胸部外科学会アンケート集計によれば，2001～2018年における急性期心室中隔穿孔（VSP）手術症例数は平均235例，入院死亡率は35.2％であった（図1）．症例数，成績とも明瞭な改善傾向はみられず，むしろわずかに悪化傾向にもみえる．Roncoらは世界26施設の共同研究においてVSP手術の早期死亡率は40.6％で，過去20年において明瞭な改善傾向はないと報告している1）．

Mean number of emergency surgery for post infarction ventricular septal perforation （VSP） in Japan from 2001 to 2018 was 235 cases/year, with 35.2％ of in hospital mortality. There was no apparent improvement in surgical results in Japan, nor worldwide for this disease during last two decades. In this report, overview of current surgical techniques for VSP was described. Infarction exclusion technique, entire septal patch technique, and sandwich technique through right ventricle incision were summarized. To further improve surgical results for VSP, pre-operative mechanical assist in critically ill patients, or development of new surgical technique using plug device may be necessary.