Yamaguchi Ryo, Ohki Satoshi, Yasuhara Kiyomitsu, Okonogi Shuichi, Nagasawa Ayako, Miki Takao, Kato Yusuke, Obayashi Tamiyuki
Department of Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, Gunma, 372-0817, Japan.
Gen Thorac Cardiovasc Surg Cases. 2024 Feb 27;3(1):16. doi: 10.1186/s44215-024-00139-5.
Left ventricular pseudo-false aneurysm is a rare complication of myocardial infarction and generally caused by an intramyocardial dissecting hematoma due to a fragile myocardium. The serpiginous dissecting case of ventricular septal perforation has an entry port in the left ventricle and exit port in the right ventricle, and the entry port must be closed to leave the dissected chamber on the low-pressure right side for treatment. Herein, we report a case of a large left ventricular pseudo-false aneurysm that was unaccompanied by a shunt after the surgical repair of a ventricular septal dissection.
A 72-year-old woman underwent percutaneous coronary intervention to the right coronary artery; 3 days later, she was urgently referred to our hospital with ventricular septal perforation. The patient was treated with sandwich patch repair via a right ventricular incision. Postoperative transthoracic echocardiography revealed no residual shunt. However, 3 months postoperatively, enhanced chest computed tomography revealed a large left ventricular pseudo-false aneurysm bulging on the right ventricular side, causing congestive heart failure. An intra-aortic balloon pump was inserted for treatment. In our case, the left ventricular pseudo-false aneurysm was caused by the closure of only the exit port in the right ventricle and insufficient closure of the entry port in the left ventricle during ventricular septal dissection. Therefore, we closed the entry port through a pseudo-false aneurysm using a Dacron patch during the second surgery.
Recognizing and identifying the ventricular septal dissection after myocardial infarction are crucial for providing the best treatment and surgical approaches. When ventricular septal dissection is treated using sandwich patch repair via a right ventricular incision, the entry port in the left ventricle must be securely closed with a large patch using transmural mattress sutures.
左心室假性动脉瘤是心肌梗死的一种罕见并发症，通常由心肌脆弱导致心肌内夹层血肿引起。室间隔穿孔的蜿蜒夹层病例在左心室有入口，在右心室有出口，必须封闭入口，使夹层腔留在低压的右侧进行治疗。在此，我们报告一例在室间隔夹层手术修复后出现的大型左心室假性动脉瘤且无分流的病例。
一名72岁女性接受了右冠状动脉的经皮冠状动脉介入治疗；3天后，因室间隔穿孔被紧急转诊至我院。患者通过右心室切口采用三明治补片修复治疗。术后经胸超声心动图显示无残余分流。然而，术后3个月，胸部增强计算机断层扫描显示右心室侧有一个大型左心室假性动脉瘤膨出，导致充血性心力衰竭。插入主动脉内球囊泵进行治疗。在我们的病例中，左心室假性动脉瘤是由于室间隔夹层时仅封闭了右心室的出口而左心室入口封闭不充分所致。因此，我们在第二次手术中通过使用涤纶补片经假性动脉瘤封闭了入口。
识别和鉴定心肌梗死后的室间隔夹层对于提供最佳治疗和手术方法至关重要。当通过右心室切口采用三明治补片修复治疗室间隔夹层时，必须使用透壁褥式缝线用大补片牢固封闭左心室的入口。
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