心室中隔穿孔に対する手術の新しいテクニック

抄録

Introduction: Ventricular septal perforation (VSP) after acute myocardial infarction (AMI) is often complicated by a worsening of rapid hemodynamics, thus remaining a poor prognostic emergency disease. In our department, during the repair of VSPs with lesions in the left anterior descending artery area, infarct lesions are pre-operatively detected with ECG synchronized contrast computed tomography, and the scope of approach and exclusion is determined. Furthermore, in order to prevent complications of residual shunt, a double patch exclusion technique (DPET) is used in combination to preserve left ventriclar function.

Materials: We identified two consecutive VSP patients who underwent this procedure from September to December 2015. There was an average of five days between AMI and the onset of VSP, and an average of one day between onset of VSP and surgery.

Results: All cases were extubated on the day after surgery and intra-aortic balloon pump assistance was also withdrawn. Without perioperative complications, patients were able to leave the intensive care unit, on average, 6.5 days post-operation. Early postoperative echocardiographic and magnetic resonance angiography showed good left ventricular wall contraction except at the infarcted area, with no evidence of residual shunt.

Conclusion: The use of the double patch exclusion technique prevents residual shunt more effectively that in cases without, and it is thought that it is useful for maintaining postoperative cardiac function.