偽性仮性心室瘤に対し左室形成術を施行し良好な経過を得た1例

Successful Surgical Repair of a Pseudo-pseudo Left Ventricular Aneurysm Following Myocardial Infarction：Report of a Case

はじめに　心室瘤は心筋梗塞後の5〜12％に発症し，偽性仮性心室瘤は約0.2％とされ，きわめてまれな疾患である1）．われわれは心筋梗塞後に左室下壁に発生し，偽性仮性心室瘤と考えられた1例を経験したので報告する．

A 76-year-old woman underwent percutaneous coronary intervention （PCI） to the right coronary artery for subacute myocardial infarction six months earlier. Subsequently, PCI was also performed for a residual lesion in the left anterior descending artery. On follow-up transthoracic echocardiography, performed six months later, a localized bulging of the inferior wall of the left ventricle was observed, which had markedly enlarged compared to the previous study, leading to the decision for surgical intervention. Intraoperatively, there were no significant adhesions between the aneurysm and the pericardium. A saccular aneurysm was identified in the inferior wall of the left ventricle. A thin layer of myocardial tissue was observed beneath the epicardium, suggesting the diagnosis of a pseudo-pseudoaneurysm. The aneurysm was incised, and patch closure was performed at the aneurysmal orifice. The postoperative course was uneventful. Left ventricular pseudo-pseudoaneurysm is an extremely rare entity. We report this case to highlight the effectiveness of surgical patch closure in the management of this condition.