高齢者肺動脈弁狭窄症に対し経皮的肺動脈弁形成術を施行した1例

A Case of Percutaneous Transluminal Pulmonary Valvuloplasty for an Elderly Patient with Severe Pulmonic Valve Stenosis

要旨　症例は70歳代の女性．幼少時より心雑音を指摘され50歳代に心臓超音波検査で肺動脈弁狭窄症と診断されていた．慢性的にNYHA Ⅱ度程度の症状があったが近医にてフォローされていた．2カ月前より下腿の浮腫が出現，労作時の息切れもより増悪し，慢性心不全の急性増悪の診断で入院した．重度の肺動脈弁狭窄症(圧較差≧100mmHg)による右心不全の増悪と考えられ，利尿剤の投与で症状は比較的速やかに改善したが，心不全再発の可能性が高いと考え経皮的肺動脈弁形成術(PTPV)を施行する方針とした．イノウエバルーンを用いてPTPVを施行．術後肺動脈弁狭窄の圧較差は30mmHgほどに改善し，体血圧は100/mmHg以上を維持できるようになった．今回高齢者の重症肺動脈弁狭窄症であったが，重篤な合併症を起こすことなくPTPVを施行し得た1例を経験したので報告する．

　A 70s-year-old woman had a cardiac murmur from childhood and had been diagnosed with pulmonic valve stenosis in her 50's. She chronically had a symptom of NYHA Ⅱ, but she had been going to her home doctor with medicine. She complained about progression of leg edema and shortness of breath on effort, so she was admitted to our hospital. We diagnosed her as worsening of right heart failure caused by severe pulmonic valve stenosis(pressure gradient ≧100mmHg). So we decided to undergo percutaneous transluminal pulmonary valvuloplasty(PTPV)using Inoue Balloon. After PTPV, the pressure gradient was improved remarkably(30mmHg)and her complaint has disappeared.