心室中隔穿孔に対するダブルパッチ閉鎖術後遠隔期に合併した巨大左室瘤

Giant Left Ventricular Aneurysm After Double Patch Closure of Ventricular Septal Perforation Through Right Ventriculotomy

心室中隔穿孔（VSP）は心筋梗塞後の重篤な機械的合併症の一つで，内科的治療で対処した場合の死亡率は90％以上とされているため1），外科的治療の選択が原則となる．しかし，その術式の選択については依然として議論の分かれるところである．近年，左前下行枝領域の心筋梗塞が起源であるVSPに対しても，右室切開によるアプローチからのダブルパッチ閉鎖によるサンドイッチ法が簡便で注目されている2）．

A 66-year-old man. He had myocardial infarction due to occlusion of the left anterior descending branch, which was subsequently complicated by ventricular septal perforation. Ventricular septal perforation was repaired through right ventricle incision, applying double patches for closure, and injecting glue between the patches. The early postoperative course was good, but the infarcted left ventricular anterior wall remained because of the right ventriculotomy approach. A left ventricular aneurysm was demonstrated on postoperative follow-up echocardiography, which gradually enlarged to become giant. Since symptoms of heart failure such as respiratory distress appeared, left ventriculoplasty was performed 29 months after the perforation of the initial surgery. Since thinned left ventricular wall remains following right ventriculotomy approach, risk of postoperative left ventricular aneurysm should be taken into account.