僧帽弁狭窄症を伴った肺動静脈瘻の1治験例—心疾患合併例に対する手術適応に関して

A case of pulmonary arteriovenous fistula with mitral valve stenosis

　肺動静脈瘻は1942年Shenstone^1）の外科治療成功以来，出血・塞栓症等の危険性を理由に（多発性のものを除き）発見しだい外科治療の適応とされてきた。又，心疾患を合併した症例にも適応拡大されたが，必ずしもその成績は良好とはいえない。その理由として，Le Roux^2）はいちはやく肺高血圧合併例を報告し，そのような例では肺動静脈瘻はsafety valveの役割を果しており，瘻切除は禁忌であるとした。

　今回我々は，軽度の僧帽弁狭窄症に合併した肺高血圧を伴おない肺動静脈瘻に対し，瘻を含めた右中葉切除のみを行い軽快せしめたので，この症例を報告すると共に，心疾患を伴った肺動静脈瘻におけるその手術適応について文献的考察を加えた。

The patient was a 46 year old female, who was complaining of cyanosis, dyspnea and shortness of breath on exertion. And she had received closed mitral commissurotomy 18 years before. She was diagnosed as having pulmonary arteriovenous fistula in combination with mitral valve stenosis. The fistula was located in the lateral segment of the right lung and R-L shunt of 34% was detected. The cardiac catheterization showed a pulmonary arterial pres-sure of 34/16mmHg (mean pressure=21mmHg) and a right ventricular pressure of 34/5mmllg (end-diastolic pressure=6.5mmHg), so the pulmo-nary hypertension was not seen and the right ven-tricular function didn't decrease. It was estimated that the mitral valve stenosis was not severe without pulmonary hypertension and her complaints were due to the pulmonary arteriovenous fistula. So only the right middle lobe's lobectomy was performed. After the operation, the complaints improved and cardiac failure was not seen.

In a case of pulmonary arteriovenous fistula with mitral valve stenosis, the evaluation of the obstruc-tive changes of the pulmonary arteries is very important to determine the indication of the opera-tion. If the changes is not severe as this case, the resection of the pulmonary arteriovenous fistula will be indicated irrespective of the treatment for mitral valve stenosis.