Aoki Chikashi, Tani Kengo, Taguchi Ryou, Kowatari Ryousuke, Kondo Norihiro, Minakawa Masahito, Fukuda Ikuo
Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Kyobu Geka. 2017 Nov;70(12):1000-1004.
A 73-year-old man was admitted for cardiac tamponade by oozing type left ventricular free wall rupture associated with acute myocardial infarction. Transthoracic echocardiography demonstrated moderate pericardial effusion and the presence of pseudoaneurysm within posterior wall. He went into shock with a systolic blood pressure of 60 mmHg. After introducing percutaneous cardiopulmonary support and intraaortic balloon pump, the sutureless repair was performed immediately. After having rehabilitation for right-sided hemiparesis, an elective pseudoaneurysm repair was planned. While a waiting an operation, 7 weeks later, he went into shock again with chest pain. Echocardiography and computed tomography demonstrated much amount of pericardial bloody effusion on the posterior aspect and 1.5 cm defect on the pseudoaneurysm wall. Emergently a patch closure with a bovine pericardium was performed using cardiopulmonary bypass under ventricular fibrillation through a left thoracotomy. Postoperative course was uneventful.
一名73岁男性因急性心肌梗死伴渗出型左心室游离壁破裂导致心脏压塞入院。经胸超声心动图显示中度心包积液，后壁存在假性动脉瘤。他出现休克，收缩压为60 mmHg。在引入经皮心肺支持和主动脉内球囊泵后，立即进行了无缝合修复。在右侧偏瘫康复后，计划进行择期假性动脉瘤修复。7周后，在等待手术期间，他再次因胸痛出现休克。超声心动图和计算机断层扫描显示后侧心包大量血性积液，假性动脉瘤壁有1.5 cm缺损。紧急情况下，通过左胸切口在心室颤动下使用体外循环，用牛心包进行补片修补。术后过程顺利。
