Blow out型左室破裂症例のpre-optimizationにIMPELLAが有用だった1例
症例は84歳，女性．76歳時に冠動脈肺動脈瘻結紮，冠動脈瘤切除および冠動脈バイパス術を施行された．胸痛を主訴に前医へ救急搬送され，冠動脈造影検査で急性心筋梗塞と診断された．入院翌日血圧低下をきたし，心エコー検査にて左室破裂所見を認め当院へ転院搬送となった．即日IMPELLAを導入し，1週間の全身管理後，第8病日に手術を施行した．術中所見では側壁に破裂孔を認め，パッチ閉鎖で修復した．術後24日目にリハビリ目的に転院となった．多臓器不全を合併した高齢者であり，手術リスクが高かったため，梗塞心筋のリモデリングを得るべく待機期間を設けることが修復術成功への鍵と考えた．破裂部位の拡大を防ぐべくIMPEL...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 54; no. 2; pp. 53 - 56 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本心臓血管外科学会
15.03.2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.54.53 |
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| Abstract | 症例は84歳，女性．76歳時に冠動脈肺動脈瘻結紮，冠動脈瘤切除および冠動脈バイパス術を施行された．胸痛を主訴に前医へ救急搬送され，冠動脈造影検査で急性心筋梗塞と診断された．入院翌日血圧低下をきたし，心エコー検査にて左室破裂所見を認め当院へ転院搬送となった．即日IMPELLAを導入し，1週間の全身管理後，第8病日に手術を施行した．術中所見では側壁に破裂孔を認め，パッチ閉鎖で修復した．術後24日目にリハビリ目的に転院となった．多臓器不全を合併した高齢者であり，手術リスクが高かったため，梗塞心筋のリモデリングを得るべく待機期間を設けることが修復術成功への鍵と考えた．破裂部位の拡大を防ぐべくIMPELLAにより左室を減圧し，7日間の術前期間を設けることで臓器障害も改善し，十分にpreoptimizationできた．左室破裂症例における術前IMPELLA補助下管理は，本症例のような血行動態の安定した開心術後のblow-out ruptureやoozing ruptureで有効となる可能性がある． |
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| AbstractList | 症例は84歳，女性．76歳時に冠動脈肺動脈瘻結紮，冠動脈瘤切除および冠動脈バイパス術を施行された．胸痛を主訴に前医へ救急搬送され，冠動脈造影検査で急性心筋梗塞と診断された．入院翌日血圧低下をきたし，心エコー検査にて左室破裂所見を認め当院へ転院搬送となった．即日IMPELLAを導入し，1週間の全身管理後，第8病日に手術を施行した．術中所見では側壁に破裂孔を認め，パッチ閉鎖で修復した．術後24日目にリハビリ目的に転院となった．多臓器不全を合併した高齢者であり，手術リスクが高かったため，梗塞心筋のリモデリングを得るべく待機期間を設けることが修復術成功への鍵と考えた．破裂部位の拡大を防ぐべくIMPELLAにより左室を減圧し，7日間の術前期間を設けることで臓器障害も改善し，十分にpreoptimizationできた．左室破裂症例における術前IMPELLA補助下管理は，本症例のような血行動態の安定した開心術後のblow-out ruptureやoozing ruptureで有効となる可能性がある． |
| Author | 河野, 哲也 月岡, 勝晶 内藤, 一樹 松村, 祐 大太, 創一郎 高野, 智弘 |
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| References | 6) French JK, Hellkamp AS, Armstrong PW et al. Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI). Am J Cardiol 2010; 105: 59-63. 13) Dahlin LG, Peterzén B. Impella used for hemostasis by left ventricular unloading, in a case with left ventricular posterior wall rupture. Ann Thorac Surg 2008; 85: 1445-7. 1) Zein R, Patel C, Mercado-Alamo A et al. A review of the Impella devices. Interv Cardiol 2022; 17: e05. 9) Arnaoutakis GJ, Zhao Y, George TJ et al. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg 2012; 94: 436-43; discussion 443-4. 4) Remmelink M, Sjauw KD, Henriques JP et al. Effects of left ventricular unloading by Impella recover LP2.5 on coronary hemodynamics. Catheter Cardiovasc Interv 2007; 70: 532-7. 3) Møller JE, Engstrøm T, Jensen LO et al. Microaxial flow pump or standard care in infarct-related cardiogenic shock. N Engl J Med 2024; 390: 1382-93. 10) Yalta K, Yilmaz MB, Yalta T et al. Late versus early myocardial remodeling after acute myocardial infarction: a comparative review on mechanistic insights and clinical implications. J Cardiovasc Pharmacol Ther 2020; 25: 15-26. 5) Vandenbriele C, M'Pembele R, Dannenberg L et al, Heparin dosing in patients with Impella-supported cardiogenic shock. Int J Cardiol 2024; 399: 131690. 7) Miyairi T, Orime Y, Matsumiya G et al. Coronary artery surgery in Japan in 2017. Ann Thorac Cardiovasc Surg 2019; 25: 176-8. 2) O'Neill WW, Schreiber T, Wohns DH et al.The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella Registry. J Interv Cardiol 2014; 27: 1-11. 8) Sakaguchi G, Miyata H, Motomura N et al. Surgical repair of post-infarction ventricular septal defect-findings from a Japanese National Database. Circ J 2019; 83: 2229-35. 11) Coyan G, Anand N, Imran M et al. ECMO and Impella support strategies as a bridge to surgical repair of post-infarction ventricular septal rupture. Medicina (Kaunas) 2022; 58: 611. 12) Ishikawa N, Hirofuji A, Kunioka S et al. Impella CP for treatment left ventricular free-wall rupture after myocardial infarction: report of a case. J Surg Case Rep 2020; 2020: rjaa263. |
| References_xml | – reference: 4) Remmelink M, Sjauw KD, Henriques JP et al. Effects of left ventricular unloading by Impella recover LP2.5 on coronary hemodynamics. Catheter Cardiovasc Interv 2007; 70: 532-7. – reference: 9) Arnaoutakis GJ, Zhao Y, George TJ et al. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg 2012; 94: 436-43; discussion 443-4. – reference: 11) Coyan G, Anand N, Imran M et al. ECMO and Impella support strategies as a bridge to surgical repair of post-infarction ventricular septal rupture. Medicina (Kaunas) 2022; 58: 611. – reference: 1) Zein R, Patel C, Mercado-Alamo A et al. A review of the Impella devices. Interv Cardiol 2022; 17: e05. – reference: 7) Miyairi T, Orime Y, Matsumiya G et al. Coronary artery surgery in Japan in 2017. Ann Thorac Cardiovasc Surg 2019; 25: 176-8. – reference: 3) Møller JE, Engstrøm T, Jensen LO et al. Microaxial flow pump or standard care in infarct-related cardiogenic shock. N Engl J Med 2024; 390: 1382-93. – reference: 13) Dahlin LG, Peterzén B. Impella used for hemostasis by left ventricular unloading, in a case with left ventricular posterior wall rupture. Ann Thorac Surg 2008; 85: 1445-7. – reference: 12) Ishikawa N, Hirofuji A, Kunioka S et al. Impella CP for treatment left ventricular free-wall rupture after myocardial infarction: report of a case. J Surg Case Rep 2020; 2020: rjaa263. – reference: 5) Vandenbriele C, M'Pembele R, Dannenberg L et al, Heparin dosing in patients with Impella-supported cardiogenic shock. Int J Cardiol 2024; 399: 131690. – reference: 10) Yalta K, Yilmaz MB, Yalta T et al. Late versus early myocardial remodeling after acute myocardial infarction: a comparative review on mechanistic insights and clinical implications. J Cardiovasc Pharmacol Ther 2020; 25: 15-26. – reference: 6) French JK, Hellkamp AS, Armstrong PW et al. Mechanical complications after percutaneous coronary intervention in ST-elevation myocardial infarction (from APEX-AMI). Am J Cardiol 2010; 105: 59-63. – reference: 2) O'Neill WW, Schreiber T, Wohns DH et al.The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella Registry. J Interv Cardiol 2014; 27: 1-11. – reference: 8) Sakaguchi G, Miyata H, Motomura N et al. Surgical repair of post-infarction ventricular septal defect-findings from a Japanese National Database. Circ J 2019; 83: 2229-35. |
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| SubjectTerms | Impella 左室破裂 心筋梗塞 |
| Title | Blow out型左室破裂症例のpre-optimizationにIMPELLAが有用だった1例 |
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| ispartofPNX | 日本心臓血管外科学会雑誌, 2025/03/15, Vol.54(2), pp.53-56 |
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