真性左室瘤に合併した巨大仮性心室瘤

A Giant Pseudoaneurysm Associated with a True Left Ventricular Aneurysm

心筋梗塞後に発症する心室瘤は，瘤の組織学的構造や形態から真性心室瘤と仮性心室瘤に分けられる．特に仮性心室瘤は破裂の危険性が高く，早期の手術加療が必要とされる1）．

A 66-year-old man developed exertional dyspnea. The patient had undergone total arch replacement for a dissecting aortic arch aneurysm at the age of 53 and conservative treatment for myocardial infarction at the age of 60. Several imaging studies revealed a giant pseudoaneurysm that likely originated from a true ventricular aneurysm. The pseudoaneurysm severely compressed the right ventricle. Surgery was promptly performed. The patient had a history of cardiac surgery and had exclusively dense pericardium adhesion. Therefore, we incised the pseudoaneurysm and sutured the rupture orifice directly from inside the pseudoaneurysm under rapid pacing. This approach may represent an effective surgical alternative in patients with small rupture orifice and dense adhesions.