慢性心タンポナーデに対するcontrolled drainage法の経験

Chronic Cardiac Tamponade Treated with Controlled Drainage

要旨　患者は48歳，女性．咳嗽，強い胸背部痛，嘔吐を伴う嚥下困難で来院し，CT検査で食道下部を圧迫する大量の心囊液貯留を認めた．剣状突起下アプローチで緊急心囊穿刺後，心囊内圧をモニター下に緩徐なドレナージ(平均453ml/日)を施行した．2,000mlのドレナージで心囊内圧は20から0mmHgまで除圧でき，嚥下障害は軽快した．一方エコー上僧帽弁逆流は悪化し，末梢血管抵抗の持続的亢進を認めた．慢性心タンポナーデに対し緩徐なドレナージで十分な心囊内圧の除圧を行ったが，循環動態悪化の回避に限界を呈した．

　A 48-year-old woman presented with cough, severe chest and back pain, and dysphagia with vomiting. Computed tomography indicated the presence of a massive pericardial effusion, which compressed the lower portion of the esophagus. The patient underwent an emergency subxiphoid pericardiocentesis and controlled drainage(mean drainage volume, 453ml/day)with monitoring of intrapericardial pressure. The total drainage volume was 2,000ml, and the mean intrapericardial pressure was reduced from 20 to nearly 0 mmHg. However, she continued to exhibit an elevated peripheral vascular resistance as well as worsening of mitral regurgitation on echocardiography. Thus, in the present case, gradual fluid drainage with pericardial decompression for the treatment of chronic cardiac tamponade had certain limitations as it was unable to prevent the development of hemodynamic derangements.