Journal of Chest Surgery

  • 제36권5호
  • /
  • Pages.363-366
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  • 2003
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  • 2765-1606(pISSN)
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  • 2765-1614(eISSN)
대한심장혈관흉부외과학회 (The Korean Society for Thoracic and Cardiovascular Surgery)
권호 표지

급성심근경색 후 발생한 좌심실벽 파열에서 소심낭과 Fibrin Glue 압박을 이용한 치험 - 1예 보고 -

Repair of Left Ventricular Free Wall Rupture after Acute Myocardial Infarction: Application of Pericardial Patch Covering and Fibrin Glue Compression A case report

  • 김상익 (을지의과대학 부속병원 흉부외과) ;
  • 금동윤 (을지의과대학 부속병원 흉부외과) ;
  • 원경준 (을지의과대학 부속병원 흉부외과) ;
  • 오상준 (을지의과대학 을지병원 흉부외과)
  • 발행 : 2003.05.01
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초록

배경: 급성심근경색 후 좌심실벽 파열은 높은 사망률을 보이는 심각한 합병증으로 보통 응급 수술이 유일한 치료법이다. 지속적인 흉통과 실신을 주소로 내원한 76세 여자 환자로 심초음파에서 심낭 삼출 및 좌심실 측하부의 수축 저하 소견을 보였고 관상동맥조영술에서 첫 사선지의 완전 폐쇄소견이 관찰되었다. 폐쇄된 사선지에 관상동맥성형술 및 스텐트 삽입, 그리고 대동맥내 풍선펌프 삽입 후 응급수술을 시행하였다. 체외순환 및 심정지하에 관상동맥우회술을 시행하고 좌심실벽 파열부위는 소 심낭으로 덮고 인조사로 연속 봉합하였으며 소 심낭과 심장외막 사이의 공간은 fibrin glue로 채운 후 지혈될 때까지 압박하였다. 급성심근경색 후 발생한 좌심실벽 파열을 치험하였기에 보고한다.

Background: Left ventricular rupture after acute myocardial infarction is a serious complication with high mortality. Emergency operation is usually the only available treatment. A 76-year-old female with persistent chest pain and syncopal attacks was admitted. Transthoracic echocardiography showed the pericardial effusion and generalized hypokinesia of the inferolateral wall of left ventricle. Coronary angiography revealed a total occlusion of the first diagonal branch. After percutaneous transluminal coronary angioplasty with coronary stent and insertion of intraaortic balloon pump, emergency operation was performed. Under cardiopulmonary bypass and cardiac arrest with cold blood cardioplegia, coronary artery bypass graft with saphenous vein, pericardial patch covering on the rupture area with 6-0 polypropylene running sutures, and fibrin glue compression under the patch were performed. We present a case of left ventricular (free wall) rupture after acute myocardial infarction.

키워드

참고문헌

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