Sudo Y, Takahara Y, Ohto T, Murayama H, Nakada I, Nakamura T
Department of Cardiovascular Surgery, Chiba Prefectural Cardiopulmonary Center, Tsurumai Hospital, Ichihara, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1992 Nov;40(11):2075-81.
A 69-year-old female patient with acute myocardial infarction was admitted to our hospital. After i.v. administration of the rt-PA, echocardiography disclosed pericardial effusion to which pericardial drainage was performed first through subxiphoid incision. Immediately after the drainage, electromechanical dissociation emerged and emergency thoracotomy was performed. There was a small blowout rupture of the left ventricular free wall that was successfully repaired using single suture buttressed with Dacron felt without cardiopulmonary bypass support. On the 38th day after the surgery, cineangiography disclosed ventricular aneurysm, to which aneurysmectomy was performed under the cardiopulmonary bypass and her post operative progress was uneventful. Histological study of the resected specimen revealed so called subepicardial aneurysm. Although blowout rupture of the left ventricular free wall used to be lethal, there might be a chance of life saving even without cardiopulmonary bypass support, if the left thoracotomy could be done as quickly as possible.
一名69岁的急性心肌梗死女性患者入住我院。静脉注射rt-PA后，超声心动图显示心包积液，首先通过剑突下切口进行心包引流。引流后立即出现电机械分离，遂行急诊开胸手术。发现左心室游离壁有一小的破裂口，在无体外循环支持的情况下，使用带涤纶毡片的单缝合法成功修复。术后第38天，血管造影显示心室壁瘤，遂在体外循环下行瘤切除术，术后恢复顺利。切除标本的组织学研究显示为所谓的心外膜下壁瘤。尽管左心室游离壁破裂过去通常是致命的，但如果能尽快进行左胸开胸手术，即使没有体外循环支持，也可能有挽救生命的机会。
