Ebstein奇形に合併した肺塞栓症の1例

Massive pulmonary embolism in a patient with Ebstein's anomaly

　肺塞栓症は静脈系に発生した栓子（血栓・腫瘍・脂肪等）の遊離により生ずる肺血管床の急激な閉塞により起こり，栓子の大きさ・基礎疾患の状態により種々の臨床像を呈する疾患である。近年我々はEbstein奇形に合併した肺塞栓症を経験したので報告する。

　A 31 year old man with Ebstein's anomaly was admitted because of unconsciousness. The electrocardiogram revealed ventricular tachycardia, which was treated with lidocaine. On the 4th hospital day, he suddenly developed dyspnea and non-pleuritic chest pain. He was diaphoretic and cyanotic (PaOs₂ 42 mmHg). A lung scans demonstrated perfusion defects with normal ventilation in both lungs (V/Q mismatching). Cut off sign of intermediate portion of right pulmonary artery was documented on right ventriculography. The patient was successfully treated with heparin and urokinase. Two weeks later, repeated lung scans and pulmonary angiography essentially negative. At cardiac catheterization the intracavitary electrocardiogram recorded just proximal to the tricuspid valve showed a right ventricular type of complex, while the pressure recorded was that of right atrium. The source of thrombi could not found in right atrium or leg deep veins.