Kimura Naoyuki, Kawahito Koji, Murata Seiichiro, Yamaguchi Atsushi, Adachi Hideo, Ino Takashi
Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, Saitama, Japan.
Jpn J Thorac Cardiovasc Surg. 2005 Jul;53(7):382-5. doi: 10.1007/s11748-005-0055-1.
A 55-year-old man was admitted for acute myocardial infarction. Cardiac catheterization revealed total occlusion of the left circumflex artery. During catheterization, he suffered cardiogenic shock. Percutaneous cardiopulmonary support was established, and the patient was transferred to the operating room. A blow-out left ventricular free wall rupture (LVFWR) with an epicardial tear, 1 mm in diameter, was found, and sutureless repair with a collagen hemostat (TachoComb) was performed. However, on postoperative day 7, echocardiography revealed an echo-free space resembling a pseudoaneurysm. A second operation was performed immediately for impending re-rupture. An epicardial tear, 2 x 10 mm in diameter, was found at the previous bleeding point where hemostasis had been achieved with only one sheet of TachoComb. The defect was closed with mattress sutures buttressed with Teflon felt. We conclude that even if the risk of re-rupture is low, sutureless repair with a collagen hemostat alone should be avoided in treating blow-out LVFWR.
一名55岁男性因急性心肌梗死入院。心脏导管检查显示左旋支动脉完全闭塞。在导管检查过程中，他发生了心源性休克。建立了经皮心肺支持，患者被转至手术室。发现左心室游离壁破裂（LVFWR）伴直径1毫米的心外膜撕裂，采用胶原止血剂（速即纱）进行了无缝合修补。然而，术后第7天，超声心动图显示一个类似假性动脉瘤的无回声区。因即将再次破裂立即进行了二次手术。在先前仅用一片速即纱止血的出血点发现一个直径2×10毫米的心外膜撕裂。用带聚四氟乙烯垫片的褥式缝线封闭缺损。我们得出结论，即使再次破裂的风险较低，在治疗暴发性LVFWR时也应避免仅用胶原止血剂进行无缝合修补。
