急性心筋梗塞後の重複破裂に対し二期的手術で救命しえた1例

Successful Staged Repair of Double Rupture after Acute Myocardial Infarction：Report of a Case

はじめに　急性心筋梗塞（AMI）後の機械的合併症には左室自由壁破裂（LVFWR），心室中隔穿孔（VSP），乳頭筋断裂（PMR）があるが，この三つの病態のうち二つを合併するものを重複破裂（double rupture）と呼び，非常にまれで予後不良な病態である1）．われわれは，AMI後に重複破裂（LVFWR，VSP）を発症し，二期的手術で救命しえた症例を経験したので，文献的考察を加えて報告する．

Double rupture is a very rare, and life-threatening complication after acute myocardial infection （AMI）, which defined as the coexistence of any two of the three types of rupture include left ventricular free wall repture （LVFWR）, ventricular septal perforation （VSP） and papillary muscule repture （PMR）. We report here a case of successful staged repair of double rupture combined LVFWR and VSP. A 77-year-old woman with diagnosis of AMI in the anteroseptal area fell into cardiogenic shock suddenly just before starting coronary angiography. Echocardiography showed left ventricular free wall rupture, then an emergent operation was performed under intraaortic balloon pumping （IABP） and percutaneous cardiopulmonary support （PCPS） assistance using bovine pericardial patch and felt sandwich technique. Intraoperative transesophageal echocardiography revealed ventricular septal perforation on the apical anterior wall. Her hemodynamic condition was stable, therefore we selected a staged VSP repair to avoid surgery on freshly infarcted myocardium. Twenty-eight days after the initial operation, VSP repair was performed using the extended sandwich patch technique via right ventricle incision. Postoperative echocardiography revealed no residual shunt.