心室中隔穿孔に対し大動脈内バルーンパンピングを挿入し準緊急手術を行い救命した1例

Semi-acute Surgery for Ventricular Septal Perforation After Unsuccessful Intra-aortic Balloon Pumping Support：Report of a Case

はじめに　心室中隔穿孔（VSP）は急性心筋梗塞後の重篤な合併症の一つである．発症率は0.17％程度1）と高くないが，急激な血行動態の破綻を招き，その予後はいまだ不良な疾患である．手術治療がほぼ必須であるがその成績もいまだ良好とはいえず，2018年の日本胸部外科学会からの報告では急性期のVSPに対する30日死亡率は23.9％であった2）．VSPに対する手術介入の時期に関しては，血行動態が保たれているならば待期的に行うほうが治療成績は良好であることが示されている3）．

Ventricular septal perforation （VSP） after acute myocardial infarction （MI） is a serious condition that requires surgical treatment. However, good outcome is not always obtained. The mortality rate of VSP is particularly high in cases whom emergency surgery is performed early in the course of the disease, and the timing of surgery is known to affect prognosis. In this case report, the patient assisted with intra-aortic balloon pump. VSP closure surgery （a modified David-Komeda technique） underwent 8 days after MI onset. Except for mild residual shunt, the patient experienced no adverse event during postoperative course and was discharged 30 days after the surgery. This case illustrated timing of surgery as well as adequate mechanical cardiopulmonary assistance and surgical technique is important.