Ueyama K, Koyama M, Otaki K, Terashima T, Nishimiya T
Department of Cardiovascular Surgery, Asahikawa Red-cross Hospital, Asahikawa, Japan.
Kyobu Geka. 2009 Mar;62(3):215-8.
A 69-year-old man was referred to our hospital due to acute myocardial infarction. Systolic heart murmur was first noted on the 23rd day after the onset, but no cardiac shunt flow was detected by echocardiography at that time. Six days later, cardiac function deteriorated rapidly, followed by oliguria and shock. Re-do echocardiography showed ventricular septal perforation. Emergency operation was performed, and septal perforation was seen on the anterior portion of the septum. In addition to infarct-exclusion-technique (Komeda-David method) with the equine pericardial patch, direct closure of the septal defect was performed (double closure technique). Fibrin glue was applied between the ventricular septum and the patch. After surgery, he suffered from Candida mediastinitis and received omentum plombage. Furthermore tracheotomy was performed for pneumonia. He recovered gradually, and was discharged about 3 months after surgery. Echocardiography showed no residual shunt.
一名69岁男性因急性心肌梗死被转诊至我院。发病后第23天首次发现收缩期心脏杂音，但当时超声心动图未检测到心脏分流。6天后，心功能迅速恶化，随后出现少尿和休克。再次超声心动图显示室间隔穿孔。进行了急诊手术，可见室间隔前部穿孔。除了使用马心包补片进行梗死灶排除技术（小牧-大卫法）外，还进行了室间隔缺损的直接闭合（双重闭合技术）。在室间隔和补片之间应用了纤维蛋白胶。术后，他患上了念珠菌纵隔炎并接受了大网膜填充术。此外，因肺炎进行了气管切开术。他逐渐康复，术后约3个月出院。超声心动图显示无残余分流。
