Ikuta Takeshi, Kishimoto Noriaki, Fujii Hirofumi, Kimura Eiji, Shimizu Yoshihiro
Department of Cardiovascular Surgery, Ishikiriseiki Hospital, Higashiosaka, Japan.
Kyobu Geka. 2018 Sep;71(9):669-673.
Ventricular septal rupture(VSR) after acute myocardial infarction(AMI) is a rare and serious complication that is associated with extremely high mortality. Delayed VSR is particularly uncommon and is difficult to diagnose and treat. A 68-year-old man presented with dyspnea on effort. Coronary angiography revealed subtotal occlusion of the right coronary artery(RCA) with collateral circulation to the chronically and totally occluded left anterior descending artery (LAD). Elective stenting of the RCA was successfully performed for a recent MI of the RCA, while percutaneous coronary intervention(PCI) in the LAD ended in failure. At 21 days after the 1st PCI, the patient developed acute heart failure with new pansystolic murmur. Cardiac catheterization showed a left to right ventricular shunting without new coronary artery lesions. Fortunately, the hemodynamic status was stable, and we could perform elective surgical repair by right atrial approach. Simultaneously, a left internal thoracic artery bypass to the LAD was performed. The postoperative course was uneventful. The patient is currently doing well at 5 years after the operation.
急性心肌梗死（AMI）后室间隔破裂（VSR）是一种罕见且严重的并发症，死亡率极高。延迟性VSR尤为罕见，诊断和治疗都很困难。一名68岁男性因劳力性呼吸困难就诊。冠状动脉造影显示右冠状动脉（RCA）次全闭塞，通过侧支循环为慢性完全闭塞的左前降支动脉（LAD）供血。因近期RCA心肌梗死，成功对RCA进行了择期支架置入术，而LAD的经皮冠状动脉介入治疗（PCI）以失败告终。在首次PCI术后21天，患者出现急性心力衰竭并伴有新的全收缩期杂音。心导管检查显示左向右心室分流，无新的冠状动脉病变。幸运的是，血流动力学状态稳定，我们能够通过右心房途径进行择期手术修复。同时，对LAD进行了左胸廓内动脉搭桥术。术后过程顺利。患者术后5年目前情况良好。
