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Kokyu to Junkan Volume 34, Issue 5 （May 1986）

呼吸と循環 34巻5号（1986年5月発行）

Japanese English

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症例

肺動脈血栓別除術が成功した慢性反復性肺塞栓症の1例 Successfully operated case of recurrent pulmonary thromboembolism with disabling chronic cor pulmonale 山本勝広 ¹ , 大久保俊平 ¹ , 内藤雅裕 ¹ , 中西宣文 ¹ , 藤井隆 ¹ , 平盛勝彦 ¹ , 国枝武義 ¹ , 古岡公夫 ² , 安藤太三 ³ , 上村重明 ³ , 中島伸之 ³ Katsuhiro Yamamoto ¹ , Shumpei Okubo ¹ , Masahiro Naito ¹ , Takashi Fujii ¹ , Katsuhiko Hiramori ¹ , Takeyoshi Kunieda ¹ , Takao Yoshioka ² , Motomi Ando ³ , Shigeaki Uemura ³ , Nobuyuki Nakajima ³ ¹国立循環器病センター内科 ²国立循環器病センター研究所 ³国立循環器病センター外科 ¹Division of Cardiology,National Cardiovascular Center ²Research Institute, National Cardiovascular Center ³Division of Vascular Surgery, National Cardiovascular Center pp.565-570

発行日 1986年5月15日 Published Date 1986/5/15

DOI https://doi.org/10.11477/mf.1404204875

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Abstract 文献概要
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　肺塞栓症は，我国においては比較的まれな疾患とされていたが，近年の生活様式の変化や診断技術の向上からかその頻度は増加傾向にある^1）。一般に急性肺塞栓症に対してはヘパリン等による抗凝固療法や，urokinaseなどによる血栓溶解療法により，大きな治療効果が期待できるが，肺塞栓の反復性再発による慢性反復性肺塞栓症は治療抵抗性であり，肺高血圧の合併による右心不全や呼吸不全のため，その予後はきわめて不良である^2〜4）。

　今回我々は，約4年間にわたり肺塞栓症を繰り返し，肺高血圧，右心不全を呈した慢性反復性肺塞栓症例に対して，肺動脈血栓別除術を施行し，自覚症状，他覚所見ともに著明な改善が認められたので報告する。

A successfully operated case of recurrent pulmonary thromboembolism with disabling chronic cor pulmonale was reported. A 39-year-old man with dyspnea and chest pain on exertion for four years was admitted to our hospital. A marked jugular vein distension, a prominent P2, and a Grade 3/6, soft holosystlic tricuspid regurgi-tant murmur were noted. The liver was palpated 4. 5cm below the right costal margin. Chest X-ray film showed mild cardiomegaly and the lung vascularity was decre-ased in the right lung. ECG demonstrated abnormal Q waves in III, and _aV_F, and ST segments were depressed in V_2~4, and T waves were inverted in leads II, III, _aV_F, and V_1~6. A perfusion lung scan revealed that the blood How to the right middle and lower lung was totally absent, and several areas of perfusion defects were also observed in the left lung. Right-sided cardiac catheterization revealed that the PA pressure was 75/15 mean 57) mmHg, and the CO was 2.6L min. Pul-monary arteriogram demonstrated complete occlusion of the right middle and lower lobe arteries and partial occlusion of the left pulmonary arteries. Right pulmon-nary arteries distal to the occluded segments were found to be patent and filled by collaterals from the right coronary artery and bronchial artery. Pulmonary embo-lectomy was performed. Large, organized, adherent thrombi were found and removed from the right main PA as well as from middle and lower lobe branches.After operation, his exercise capacity markedly improved with significant fall in the PA pressure. Post operative pulmonary angiogram confirmed the re-establishment of the blood flow in the right lung.

This case indicates that there exist some cases of recurrent pulmonary thromboembolism in whom surgi-cal operation can dramatically improve their conditions.