心室中隔穿孔を伴った心筋梗塞後心室中隔血腫に対する右室ダブルパッチ法

Double Patch Technique via Right Ventriculotomy After Ventricular Septal Perforation with Intramyocardial Dissecting Hematoma

1）左房背側まで広がるIDHがVSPに開口した稀有な症例を経験した．

An 86-year-old female was taken to hospital with complaints of general malaise and anorexia. Echocardiography showed an abnormal space between the ventricles, extending to the back of the left atrium, with a shunt from the left ventricle into both that abnormal space and the right ventricle. The next morning, the patient had a large amount of tarry stool and progressive anemia. A contrast-enhanced computed tomography （CT） revealed an opacified space behind the left atrium. The cardiologist considered the possibility of a pseudoaneurysm behind the left atrium perforated into the esophagus, and the patient was referred to our department for surgical treatment. An emergency operation was performed to repair the pseudoaneurysm behind the left atrium. We found a 5-mm defect just below the tricuspid valve. There was a space between the ventricles that communicate to the defect and to the rear. A defect also leaded to the left ventricle. The defect was closed using double patches placed in “sandwich” fashion, one on the left ventricle side and another on the right ventricle side. Postoperative contrast-enhanced CT scan revealed blood clot in the space between the ventricles.