脳梗塞の発症を契機に診断された心筋梗塞後巨大左室仮性瘤の1例

Giant Post-infarction Left Ventricular Pseudoaneurysm Diagnosed Soon After the Onset of Cerebral Infarction：Report of a Case

はじめに　左室仮性瘤は急性心筋梗塞後の合併症の一つで，高頻度に左室内血栓を合併することが知られている1，2）．しかし，脳梗塞の頻度は多くなく，脳梗塞を契機に手術適応とした報告は少ない．また，その手術方法についての一定の見解はない．われわれは，脳梗塞の発症を契機に診断された巨大左室仮性瘤に対し，心外アプローチで二重パッチ修復を行い良好な経過を得たので報告する．

A 59-year-old man was admitted to our hospital with left hemiplegia. A computed tomography （CT） scan and echocardiography revealed a cerebral infarction in the right middle cerebral artery’s territory, as well as a large pseudoaneurysm （4×3 cm） of the lateral left ventricular wall. The patient agreed to undergo cardiac surgery because of the high risk of rupture and recurrent cerebral infarctions. Owing to the high probability of damaging the posterior papillary muscle and coronary arteries, an extracardiac approach was used, and the pseudoaneurysm cavity was closed using double-patch repair. The patient was discharged from the hospital on the 12th postoperative day without any complications. Both postoperative CT and echocardiography showed closure of the cavity.