| A Case of Postinfarction Left
Ventricular Free Wall Rupture in an Elderly Patient |
(Department of Cardiovascular Surgery, Okaya Enrei
Hospital, Okaya, Japan and The Second Department of Surgery, Nihon
University School of Medicine*, Tokyo, Japan)
| Isamu Yoshitake |
Hiroaki Hata |
Tsutomu Hattori |
| Satoshi Unosawa |
Mitsuo Narata* |
Motomi Shiono* |
| Nanao Negishi* |
Yukiyasu Sezai* |
|
|
An 85-year-old man was admitted
complaining of chest pain. The ECG showed ST depression in leads
II, III, aVF, V3～V6
and Q wave in leads I, aVL with elevation
in ST segments. An emergency coronary angiography revealed 75%
stenosis in the left main trunk, 75-90% stenosis in the left
anterior descending artery, total occlusion in the acute marginal
branch, 75% stenosis in the left circumflex artery, and 75% stenosis
in the right coronary artery. He was treated medically, because
he was old and his hemodynamics were stable. About 39h later,
he lost consciousness suddenly and was shown to have cardiogenic
shock. Echocardiogram revealed pericardial effusion. Percutaneous
drainage was performed, resulting in improved blood pressure
and level of consciousness. He was transferred to Okaya Enrei
Hospital and received emergency surgery for subacute LVFWR. A
sutureless repair and coronary bypass was performed under cardiopulmonary
bypass and cardiac arrest. He experienced no major complication
and was discharged 40 days after surgery. It is concluded that
the sutureless technique allowed for a shorter operation time
and concomitant coronary bypass successfully prevented pseudo-aneurysm
and improved cardiac function. A higher quality operation is
possible by using a combination of on-pump, cardiac arrest, coronary
bypass and left ventricle repair with the sutureless technique
in such cases in which treatment is needed for cardiac arrest
as in the above example. This method contributed to an improved
prognosis.
Jpn. J. Cardiovasc. Surg. 33: 166-170 (2004) |
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