心筋梗塞後心室中隔穿孔５例の手術経験

Abstract

Of 301 patients with acute myocardial infarction admitted to our medical center during a recent 6-year period, 5 (1.7%) sustained ventricular septal perforation (VSP). The mean age of the two men and three women was 66 years, with a range of 55 to 74 years. All patients were operated upon within 3 weeks of the onset of myocardial infarction; two required emergency operation within 1 week of the onset of myocardial infarction. A trans-infarct ventriculotomy was used in all patients, and the VSP was closed with a Teflon felt patch in all but one. The incised ventricle was directly closed with interrupted mattress sutures reinforced with Teflon felt strips in four patients, and free wall resection with graft replacement was performed in one. All patients were easily weaned from cardiopulmonary bypass with the support of intra-aortic balloon pumping. The two patients with recurrent shunts, who were treated earliest in the study period, died because of heart failure and arrhythmia. The three patients treated most recently have resumed their usual activities. Non-survivors had a larger pulmonary/systemic flow range (QP/QS) than survivors. Not only cardiac function but also indicators of general condition, such as urination and psychological state, are important considerations in the proper timing of surgery.