心タンポナーデを合併し手術にて救命し得た有意狭窄を有さない急性心筋梗塞の1例

A case of acute myocardial infarction without significant stenosis which was operated because of cardiac tamponade

　急性心筋梗塞急性期にタンポナーデのため手術を行った報告は，本邦でも散見される^1,2）ものの比較的めずらしいものと思われる。これらは心破裂例であるが，本症例は肉眼的に心筋の断裂を認めずやや異なった様相を呈している。また，本症例は急性期の冠動脈造影にて狭窄病変を認めず，急性心筋硬塞としてもめずらしいものであった。

　そこで，本症例の概要を述べると共に，これらの点につき文献的考察を加えることとした。

A 77-year-old woman who was diagnosed as acute myocardial infarction 3 days before became shock and entered our hospital. The presence of pa-radoxic pulses and the enlargement of cardiac silho-uette suggested cardiac tamponade. She underwent diagnostic coronary arteriography for aorto-coronary bypass grafting. But there was no stenoses nor obstructions on coronary arteries. Left ventriculo-graphy showed the existence of a remarkable aneu-rysm at apex. She was operated to escape from cardiogenic shock. The bulging pericardium releas-ed 500 ml of blood. The apex of the heart was briskly bleeding from a 1cm crateriform necrotized lesion. There was no tear. Aneurysmectomy was performed. Her postoperative course was good and complicated by no renal shutdown nor congestive heart failure.

We disscussed about some aspects of cardiac rup-ture and cardiac tamponade complicating acute myo-cardial infarction.