@article{oai:nagasaki-u.repo.nii.ac.jp:00019376,
 author = {久田, 洋一 and 迫, 史朗 and 泉, 賢太 and 江石, 清行},
 issue = {3},
 journal = {日本心臓血管外科学会雑誌},
 month = {May},
 note = {症例は71歳,男性.左前下行枝(#7)閉塞による急性心筋梗塞を発症した.心臓超音波検査および心臓カテーテル検査により心室中隔穿孔(VSP)と前壁中隔領域に広範な左室瘤を認めた.発症7週目に手術を施行した.手術は体外循環確立後,心停止下に左前下行枝の左側で左室瘤を縦切開した.左室瘤および VSP部をexclusionするように長楕円形のウマ心膜パッチを用いたSAVE (septal anterior ventricular exclusion)手術を施行した.VSPは心筋梗塞発症後7週目であり周囲組織は比較的強固であったことと,同部はウマ心膜パッチで exclusionすることから直接縫合閉鎖した.同時にCABG(LITA-LAD)も施行した.術後左室造影において遺残シャントを認めず良好な左室形態および左室機能が保持できた.左室瘤を伴うVSPに対して,本法は梗塞部およびVSP部もexclusionし,かつ左室形態を改善させる有用な術式と考えられた., A 71-year-old man with obstruction of the left anterior descending branch (#7) suffered an acute myocardial infarction. A ventricular septal perforation (VSP) and a widespread left ventricular aneurysm were detected in the anteroseptal region by both cardiac ultrasonography and cardiac catheterization. Surgery was performed at week 7 after onset. After establishing extracorporeal circulation, the left ventricular aneurysm was longitudinally excised from the left side of the left anterior descending branch while the patient was maintained in a state of cardiac arrest. A septal anterior ventricular exclusion (SAVE) operation was performed using oblong equine pericardial patches to exclude the left ventricular aneurysm and the VSP portion. The VSP was directly closed with sutures because the surrounding tissues were relatively strong at week 7 after the onset of the myocardial infarction and the portion was excluded with an equine pericardial patch. At the same time, CABG (LITA-LAD) was also performed. After surgery, left ventriculography found no residual shunts and we were able to obtain both a good morphology and satisfactory functioning of the left ventricle. The present method is thus considered to be an effective surgical method that excludes both the VSP portion and the infracted portion, while improving the morphology of the left ventricle for VSP with a left ventricular aneurysm., 日本心臓血管外科学会雑誌 37(3), pp.197-200; 2008},
 pages = {197--200},
 title = {急性心筋梗塞に伴う心室中隔穿孔,左室瘤に左室形成術(SAVE手術)を施行した1例},
 volume = {37},
 year = {2008}
}