Mizumoto Masahiro, Uchida Tetsuro, Hamasaki Azumi, Kuroda Yoshinori, Yamashita Atsushi, Hirooka Shuto, Ishizawa Ai, Akabane Kentaro, Sadahiro Mitsuaki
Second Department of Surgery, Yamagata University, Yamagata, Japan.
Kyobu Geka. 2020 Feb;73(2):94-98.
We report a case of patch closure of posterior type ventricular septal perforation (VSP) with posterior left ventricular aneurysm (PLVAN) through right ventricular incision. A 70-year-old man was transferred to our hospital because of persistent epigastric pain. He was diagnosed with inferior acute myocardial infarction, and percutaneous coronary intervention was performed to the right coronary artery[ atrio-ventricular(AV)]. After 2 weeks, he developed congestive heart failure and was treated with inotropic support and intra-aortic balloon pumping. Echocardiography and computed tomography (CT)showed posterior type VSP between PLVAN and the right ventricle. The operation was performed via standard median sternotomy and under cardiopulmonary bypass. After right ventricle incision parallel to the left anterior descending artery, there was VSP (20×20 mm) behind the trabecular septmarginalis (TSM). We closed VSP with a 2-layer patch (40×40 mm) consisted of Dacron and bovine pericardial patches. Postoperative echocardiography showed no residual shunt, and postoperative CT showed no enlargement of PLVAN. He was discharged home on foot without right heart failure and has been well without major complications.
我们报告了一例通过右心室切口对伴有左心室后壁瘤（PLVAN）的后型室间隔穿孔（VSP）进行补片修补的病例。一名70岁男性因持续上腹部疼痛被转诊至我院。他被诊断为下壁急性心肌梗死，并对右冠状动脉[房室（AV）]进行了经皮冠状动脉介入治疗。2周后，他出现充血性心力衰竭，并接受了强心支持和主动脉内球囊泵治疗。超声心动图和计算机断层扫描（CT）显示PLVAN与右心室之间存在后型VSP。手术通过标准正中胸骨切开术并在体外循环下进行。在平行于左前降支动脉切开右心室后，在小梁间隔边缘（TSM）后方发现VSP（20×20mm）。我们用由涤纶和牛心包补片组成的两层补片（40×40mm）封闭了VSP。术后超声心动图显示无残余分流，术后CT显示PLVAN无增大。他步行出院，无右心衰竭，且恢复良好，无重大并发症。
