3．心室自由壁破裂

Ventricular Free Wall Rupture

急性心筋梗塞（AMI）後の機械的合併症には，心室中隔穿孔，乳頭筋断裂，左室自由壁破裂（LVFWR）がある．LVFWRは予測不可能で急激な循環動態の破綻をきたす疾患であり，致命的な合併症である．しかし，適切な治療戦略により救命率を改善させることが期待できる．本稿では，手術までのマネージメントから術後管理までの一連の治療戦略についてまとめた．

Left ventricular free wall rupture （LVFWR） is a potentially fatal complication after acute myocardial infarction （AMI）. Its onset is often unpredictable and circulatory collapse develops abruptly. When cardiac tamponade is detected after AMI, pericardial drainage should be performed promptly. If percutaneous drainage is ineffective, surgical drainage should be performed without hesitation. Veno-arterial extracorporeal oxygenation （VA-ECMO） cannot necessarily provide effective brain protection because of elevated venous pressure. Although suture-less repair often results in sufficient hemostasis, recurrent rupture sometimes develops. If any type of LVFWR is suspected, immediate surgical intervention can save lives.