Two Clinical Cases of Subacute Postinfarction Rupture of the Left Ventricular Free Wall. The Usefulness of a Sutureless Technique.

  • NAKAMURA Yoshinobu
    Department of Cardiovascular and Respiratory Surgery, Tottori Prefectural Central Hospital
  • TANIGUCHI Iwao
    Department of Cardiovascular and Respiratory Surgery, Tottori Prefectural Central Hospital
  • SUZUKI Yoshimasa
    Department of Cardiovascular and Respiratory Surgery, Tottori Prefectural Central Hospital
  • MAEDA Tomoyuki
    Department of Cardiovascular and Respiratory Surgery, Tottori Prefectural Central Hospital
  • YAMAGA Takeshi
    Department of Cardiovascular and Respiratory Surgery, Tottori Prefectural Central Hospital

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Other Title
  • 亜急性型心筋梗塞後左室自由壁破裂の2例  sutureless techniqueの有用性
  • THE USEFULNESS OF A SUTURELESS TECHNIQUE
  • sutureless techniqueの有用性

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Abstract

The life-saving rate of acute postinfarction rupture of the left ventricular free wall is very low, and early diagnosis and maintenance of circulatory dynamics until surgery are extremely important, regardless of the acute (blow-out) or subacute (oozing) type. Thus we not only perform surgery as soon as possible after diagnosis, but also promptly install a cardiopulmonary supporting device, such as a PCPS, in the cases with unstable circulatory dynamics. We repaired the ruptured site of beating heart using a suture technique in one case with subacute postinfarction rupture and using a sutureless technique in another. In the former case, the myocardium was injured by ligation. This case eventually required extracorporeal circulation and re-suture, and caused difficulty with bleeding control. By contrast, the latter case showed an uneventful postoperative course. It is thought that sutureless technique may be sufficient even for slitting rupture if enough decompression of the left ventricle is attained by using some cardiopulmonary supporting device and good bleeding control is kept.

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