Rapidly Occurring Left Atrial Chamber Narrowing Percutaneous Coronary Intervention

症例は 78歳,男性.糖尿病性腎症で血液維持透析を導入された際の精査にて冠動脈三枝病変を認め,初期 治療として右冠動脈の病変に対する経皮的冠動脈形成術 percutaneous coronary intervention(PCI)を施 行した.術後 1日目より持続した発熱の精査目的に施行した造影 CTにて,術前にはなかった左房内を占拠 する腫瘤を認めたため,血行動態の破綻を危惧し,手術加療の方針となった.手術は心拍動下冠動脈バイパ ス術(左内胸動脈-鈍角枝-前下行枝,右胃大網動脈-後下行枝)を行った後,人工心肺下で心停止のもと左 房腫瘤除去術を施行した.右側左房切開で左房内を観察すると,腫瘤は左房後壁にあり,表面平滑で内膜破 綻や血腫はなかった.左房外膜を切開すると左房筋層内にあたる内部に陳旧性の血栓を認め,可及的に除去 した.左房腫瘤は,画像所見と肉眼所見から壁内血腫であり,後ろ向きに原因を検索してみると,PCIの際 に迷入したワイヤーが出血の原因であると考えられた.術後 113日目の外来受診時にも左房壁内血腫の再発 がないことを確認している.PCI後出現した左房壁内血腫に対して,心停止下での左房壁内血腫除去を行っ た稀な 1例を経験したので報告する.日心外会誌 47巻 3号:118-122(2018) キーワード:左房壁内血腫;経皮的冠動脈形成術;心拍動下冠動脈バイパス術;糖尿病性腎症

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