超低体温循環停止下両側肺動脈血栓内膜摘除術が著効したOver-Systemic肺高血圧を呈する慢性肺動脈血栓塞栓症の1例

A Successful Surgical Case of Chronic Pulmonary Thromboembolism Accompanied by Systemic Pulmonary Hypertension

要旨

　われわれは，体血圧を超える慢性肺動脈血栓塞栓性肺高血圧症に対し，肺動脈血栓内膜摘除術が著効した症例を経験したので報告する．患者は69歳，女性．現病歴は1991年より呼吸困難があり，次第に増悪し，H-JⅣ°となり来院．精査の結果，慢性肺血栓塞栓症と診断された．PA圧は平均56mmHg．麻酔導入時には72mmHg，PVRは1,050と体血圧を上回る肺高血圧であった．手術は超低体温循環停止下に血栓を内膜の内弾性板まで同時に剥ぎ取るように末梢まで多量に摘除した．人工心肺の離脱は容易であった．気道出血と再潅流性肺水腫も認めず，術後5日で抜管した．術後PA圧は18と正常になり，自覚症状は著明に改善した．血栓内膜摘除術は慢性肺血栓塞栓症に対して，数少ない有効な外科的治療法であると思われた．

Summary

　A 69-year-old female was diagnosed as having chronic pulmonary thromboembolism. We performed pulmonary thromboendarterectomy by median stenotomy with the patient under deep hypothermia and circulatory arrest. The extubation of the trachial tube was on postoperative day 5 and the stay in ICU was 12days. There were no symptoms of reperfusion pulmonary edema or pulmonary hemorrhage. Mean pulmonary pressure was reduced from 56mmHg to 14mmHg, and pulmonary vascular resistance from 1,050dyne/sec/cm^-5 and PaO₂ increased. NYHA class was improved fromⅣ toⅠ. In conlusion, though chronic pulmonary thromboembolism is a frequent cause of progressive pulmonary hypertension and carries a poor prognosis, pulmonary thromboarterectomy is useful for treating pulmonary hypertension due to chronic pulmonary thromboembolism, for improvement of dyspnea and other catherter findings.