Japanese
Title急性心筋梗塞後心室中隔穿孔の治療法の検討
Subtitle原著
Authors大林民幸*, 村井則之*, 金子達夫*, 大島茂**, 湯浅和男**, 谷口興一**
Authors(kana)
Organization*群馬県立循環器病センター心臓血管外科, **群馬県立循環器病センター循環器内科
Journal循環制御
Volume18
Number1
Page71-75
Year/Month1997/
Article原著
Publisher日本循環制御医学会
Abstract「要旨」最近5年間に9例の心室中隔穿孔(VSP)を経験した. 平均年齢は70.2歳で男女比は1：2であった. 急性心筋梗塞発症から当院入院まで平均1.7施設を転送されていた. 入院時合併症は肝機能障害4例, 腎機能障害1例, 呼吸不全1例であった. 全例に10μg/kg/min以上のカテコラミンとIABPが必要であった. 平均左右シャント率は64.9%で平均肺体血流比は2.8であった. 冠動脈造影が7例に実施され, 責任病変は全て左冠動脈前下行枝で, 病変計数は平均1.1枝であった. 6例に手術が施行され, 緊急は4例, 待機は2例であった. 術後カテコラミンは平均17.6日間必要であったが, IABPは平均4.0日, 人工呼吸器は平均4.8日で離脱できた. 手術死亡は1例(16.7%)であった. 非手術例は3例あり, 理由は高齢1例, 心破裂1例, LOS1例であった. 肺体血流比を3.0で区切ると, 3.0以上群(n=4)は入院時CPK, GPT, BUN値がいずれも3.0未満群(n=5)より高値(p<0.05)で, 死亡率が高かった(75%vs0%). 緊急手術が不可能な場合にはバルーンでVSPを閉鎖して待機的に手術することも可能だが, 可及的早期にLOSによってMOFが進行する前に手術することが重要である.
Practice基礎医学・関連科学
KeywordsPostinfarction ventricular septal perforation, Acute myocardial infarction, Coronary angiography, Surgery
English
TitleClinical Management of Postinfarction Ventricular Septal Perforation
Subtitle
AuthorsTamiyuki Obayashi*, Noriyuki Murai*, Tatsuo Kaneko*, Sigeru Osima**, Kazuo Yuasa**, Koichi Taniguchi**
Authors(kana)
Organization*Divisions of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center, **Cardiology, Gunma Prefectural Cardiovascular Center
JournalCirculation Control
Volume18
Number1
Page71-75
Year/Month1997/
ArticleOriginal article
PublisherJapan Society of Circulation Control
AbstractNine consective patients were treated postinfarction ventricular septal perforation (VSP) from 1993 to 1997. These patients were forwarded an average of 1.7 institution from onset of acute myocardial infarction to admission of our hospital. On admission four patients merged with liver dysfunction, one patient with renal dysfunction, and another one patient with respiratory insufficiency. Cathecholamine greater than 10μg/kg/min and IABP were necessary for all patients. Mean left-to-right shunt rate was 64.9 % and mean pulmonary-to-systemic blood flow ratio was 2.8. Coronary angiography was performed in seven patients：all liability lesion was LAD. Cathecholamine was needed an average of 17.6 postoperative day, IABP was able to leave an average of 4.0 postoperative day, and artificial respiratory support was removed after operation at an average of 4.8 day. Operative motality rate was 16.7 % (1/6). There were three inoperative cases：one was advanced age but survived, another two cases were died because of left ventricular free wall rupture and LOS. In the group of high pulmonary-to-systemic flow ratio of more than 3.0 (n=4), CPK, GPT, and BUN were significantly higher (p<0.05) than low flow ratio group (n=5). When emergency operation is impossibility, VSP can be closed by ballon and elective operation will become possible. But in generally, early operation is recommended to prevent multiple organ failure due to LOS. (Circ Cont 18：71〜75, 1997)
PracticeBasic medicine
KeywordsPostinfarction ventricular septal perforation, Acute myocardial infarction, Coronary angiography, Surgery

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