Miyamoto Y, Sakai K, Baba Y, Nakano S, Matsuda H
First Department of Surgery, Osaka University Medical School, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1991 Nov;39(11):2046-51.
The patient was an 85-year-old woman who developed chest pain on August 6, 1989, and was admitted to our hospital the next day. The diagnosis was acute inferior myocardial infarction. Her general condition was good at first; however, a harsh holosystolic murmur was suddenly heard 13 hours after the onset of infarction. Immediate cardiac catheterization revealed a ventricular septal perforation with a 2.2:1 shunt and total occlusion of the posterior descending artery. IABP was started 3 days after the onset of perforation. PCWP and shunt ratio decreased after starting IAPB; however, lung congestion continued to worsen. An emergency operation was performed on the 5th day after the onset of perforation. The post-operative course was uneventful. She is presently doing well 17 months after the surgery. Seven patients more than 80 years old have been surgically treated for postinfarction ventricular septal perforation in Japan and this patient is the oldest.
该患者为一名85岁女性，于1989年8月6日出现胸痛，次日入院。诊断为急性下壁心肌梗死。起初她的一般状况良好；然而，在梗死发作13小时后突然听到粗糙的全收缩期杂音。立即进行心脏导管检查显示室间隔穿孔，分流比为2.2:1，后降支动脉完全闭塞。穿孔发作3天后开始使用主动脉内球囊反搏（IABP）。开始使用IABP后，肺毛细血管楔压（PCWP）和分流比下降；然而，肺充血持续恶化。在穿孔发作第5天进行了急诊手术。术后过程顺利。目前，她在手术后17个月情况良好。在日本，已有7名80岁以上的患者接受了心肌梗死后室间隔穿孔的外科治疗，该患者是年龄最大的。
