瘤内大量血栓を認めた心室中隔穿孔修復術後遠隔期心室瘤の1例
症例は71歳女性．5年前に左室前壁の心筋梗塞による心室中隔穿孔に対しextended sandwich patch法にて修復を行った．経過は良好で独歩退院したが3年ほど経過し造影CT検査および経胸壁心臓超音波検査で心室瘤をみとめた．経時的に瘤が拡大し，瘤内に血栓を疑う所見をみとめ，呼吸苦も訴えるようになったため手術適応と判断した．手術は前回手術創を剥離後心停止下に左前下行枝左側で瘤を縦切開した．内部には術前検査の予想以上の多量血栓をみとめた．血栓を除去しDor手術を行った．心室中隔穿孔後遠隔期の心室瘤の報告は少なく，拡大する心室瘤は心破裂と脳梗塞の予防のためにも速やかな手術介入が必要と思われた...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 53; no. 2; pp. 83 - 86 |
|---|---|
| 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
15.03.2024
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.53.83 |
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| Abstract | 症例は71歳女性．5年前に左室前壁の心筋梗塞による心室中隔穿孔に対しextended sandwich patch法にて修復を行った．経過は良好で独歩退院したが3年ほど経過し造影CT検査および経胸壁心臓超音波検査で心室瘤をみとめた．経時的に瘤が拡大し，瘤内に血栓を疑う所見をみとめ，呼吸苦も訴えるようになったため手術適応と判断した．手術は前回手術創を剥離後心停止下に左前下行枝左側で瘤を縦切開した．内部には術前検査の予想以上の多量血栓をみとめた．血栓を除去しDor手術を行った．心室中隔穿孔後遠隔期の心室瘤の報告は少なく，拡大する心室瘤は心破裂と脳梗塞の予防のためにも速やかな手術介入が必要と思われた． |
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| AbstractList | 症例は71歳女性．5年前に左室前壁の心筋梗塞による心室中隔穿孔に対しextended sandwich patch法にて修復を行った．経過は良好で独歩退院したが3年ほど経過し造影CT検査および経胸壁心臓超音波検査で心室瘤をみとめた．経時的に瘤が拡大し，瘤内に血栓を疑う所見をみとめ，呼吸苦も訴えるようになったため手術適応と判断した．手術は前回手術創を剥離後心停止下に左前下行枝左側で瘤を縦切開した．内部には術前検査の予想以上の多量血栓をみとめた．血栓を除去しDor手術を行った．心室中隔穿孔後遠隔期の心室瘤の報告は少なく，拡大する心室瘤は心破裂と脳梗塞の予防のためにも速やかな手術介入が必要と思われた． |
| Author | 遠藤, 由樹 入江, 嘉仁 深田, 靖久 中野渡, 仁 |
| Author_xml | – sequence: 1 fullname: 遠藤, 由樹 organization: いわき市医療センター心臓血管外科 – sequence: 1 fullname: 入江, 嘉仁 organization: いわき市医療センター心臓血管外科 – sequence: 1 fullname: 深田, 靖久 organization: いわき市医療センター心臓血管外科 – sequence: 1 fullname: 中野渡, 仁 organization: いわき市医療センター心臓血管外科 |
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| References | 7) Stratton JR, Resnick AD. Increased embolic risk in patients with left ventricular thrombi.Circulation 1987; 75: 1004-11. 1) Asai T, Hosoda S, Suzuki T et al. Postinfaction ventricular septal defect: right ventricular approach—the extended —Sandwich” patch. Semin Thorac Surg 2012; 24: 59-62. 5) Sprito O, Bellotti P, Chiarella F et al. Prognostic significance and natural history of left ventricular thrombi in patients with acute anterior myocardial infarction: a two-dimensional echocardiography. Circulation 1985; 72: 774-80. 10) Dor V, Sbatier M, Di Danato M et al. Late hemodynamic results following left ventricular patch repair associated with coronary grafting in patients with postinfarction akinetic or dyskinetic left ventricular aneurysm. J Thorac Cardiovasc Surg 1995; 110: 1291-301. 13) Suma H. Left ventriculoplasty for nonischemic dilated cardiomyopathy. Semin Thorac Cardiovasc Surg 2001; 13: 514-21. 11) Di Donato M, Sabatier M, Dor V et al. Effects of the Dor procedure on left ventricular dimension and shape and geometric correlates of mitral regurgitation one year after surgery. J Thorac Cardiovasc Surg 2001; 121: 91-6. 3) Grodin P, Kretz G, Bical O et al. Natural history of saccular aneurysm of the left ventricle. J Thorac Cardiovasc Surg 1979; 77: 57-64. 9) Dor V, Saab M, Coste P et al. Left ventricular aneurysm: a new surgical approach. J Thorac Cardiovasc Surg 1989; 37: 11-9. 12) Cho Y, Ueda T, Inoue Y et al. Long-term results and mid-term features of left ventricular reconstruction procedures on left ventricular volume, geometry, function and mitral regurgitation. Eur J Cardiothorac Surg 2012; 42: 462-9. 8) Keren A, Goldberg S, Gottlieb S et al. Natural history of left ventricular thrombi: their appearance and resolution in the posthospitalization period of acute myocardial infarction. J Am Coll Cardiol 1990; 15: 790-800. 6) Cregler LL. Antithrombotic therapy in left ventricular thrombosis and systemic embolism. Am Heart J 1992; 123: 1110-4. 14) Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. Heart 2012; 98: 1743-9. 2) Olearchyk AS, Lemole GM, Spagna PM et al. Ten years'experience in surgical treatment of 244 cases. Improved clinical status, hemodynamics, and long-term longevity. J Thorac Cardiovas Surg 1984; 88: 544-53. 4) Baalbaki HA, Clements SD. Left ventricular aneurysm: a review. Clin Cardiol 1989; 12: 5-13. |
| References_xml | – reference: 13) Suma H. Left ventriculoplasty for nonischemic dilated cardiomyopathy. Semin Thorac Cardiovasc Surg 2001; 13: 514-21. – reference: 9) Dor V, Saab M, Coste P et al. Left ventricular aneurysm: a new surgical approach. J Thorac Cardiovasc Surg 1989; 37: 11-9. – reference: 12) Cho Y, Ueda T, Inoue Y et al. Long-term results and mid-term features of left ventricular reconstruction procedures on left ventricular volume, geometry, function and mitral regurgitation. Eur J Cardiothorac Surg 2012; 42: 462-9. – reference: 7) Stratton JR, Resnick AD. Increased embolic risk in patients with left ventricular thrombi.Circulation 1987; 75: 1004-11. – reference: 11) Di Donato M, Sabatier M, Dor V et al. Effects of the Dor procedure on left ventricular dimension and shape and geometric correlates of mitral regurgitation one year after surgery. J Thorac Cardiovasc Surg 2001; 121: 91-6. – reference: 2) Olearchyk AS, Lemole GM, Spagna PM et al. Ten years'experience in surgical treatment of 244 cases. Improved clinical status, hemodynamics, and long-term longevity. J Thorac Cardiovas Surg 1984; 88: 544-53. – reference: 4) Baalbaki HA, Clements SD. Left ventricular aneurysm: a review. Clin Cardiol 1989; 12: 5-13. – reference: 3) Grodin P, Kretz G, Bical O et al. Natural history of saccular aneurysm of the left ventricle. J Thorac Cardiovasc Surg 1979; 77: 57-64. – reference: 6) Cregler LL. Antithrombotic therapy in left ventricular thrombosis and systemic embolism. Am Heart J 1992; 123: 1110-4. – reference: 5) Sprito O, Bellotti P, Chiarella F et al. Prognostic significance and natural history of left ventricular thrombi in patients with acute anterior myocardial infarction: a two-dimensional echocardiography. Circulation 1985; 72: 774-80. – reference: 1) Asai T, Hosoda S, Suzuki T et al. Postinfaction ventricular septal defect: right ventricular approach—the extended —Sandwich” patch. Semin Thorac Surg 2012; 24: 59-62. – reference: 10) Dor V, Sbatier M, Di Danato M et al. Late hemodynamic results following left ventricular patch repair associated with coronary grafting in patients with postinfarction akinetic or dyskinetic left ventricular aneurysm. J Thorac Cardiovasc Surg 1995; 110: 1291-301. – reference: 14) Delewi R, Zijlstra F, Piek JJ. Left ventricular thrombus formation after acute myocardial infarction. Heart 2012; 98: 1743-9. – reference: 8) Keren A, Goldberg S, Gottlieb S et al. Natural history of left ventricular thrombi: their appearance and resolution in the posthospitalization period of acute myocardial infarction. J Am Coll Cardiol 1990; 15: 790-800. |
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| SubjectTerms | Dor手術 左室内血栓 心室中隔穿孔 心室瘤 |
| Title | 瘤内大量血栓を認めた心室中隔穿孔修復術後遠隔期心室瘤の1例 |
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