冠静脈走行異常に合併した連合弁膜症にみられた左房内浮遊ボール状血栓の1例

A case of left atrial ball thrombus observed in a patient with combined valvular heart disease, accompanying anomalous coronary venous run

　左房内血栓は，僧帽弁膜疾患の約10〜30％にみられ^1,2），比較的よく認められる合併症の一つである。しかし，これらの血栓が生前に浮遊ボール状の形態で観察され摘出に成功したとする報告は極めて少ない。その理由は，ボール状血栓が剥離し浮遊した場合，"Hole-in-one"sudden death^3）や全身への浮遊血栓の塞栓^4）のために早期に死亡するからである。しかし，近年心エコー法の発達により左房内血栓の検出度が向上している^5）。その結果，血栓の早期発見早期治療に結びつき，予後改善に大きな影響を与えている。

　われわれは冠静脈走行異常に合併した連合弁膜症に浮遊ボール状血栓が認められた1例を経験したので，その発生過程について本邦報告29例の文献的考察を加味しながら報告する。

A 53-year woman, who had been under observa-tion for combined valvular heart disease, was admit-ted to our hospital for further examination of em-bolic episodes to brain and kidney. Echocardio-graphic examination showed the evidence of free-moving ball thrombus in the left atrum, and emergent cardiac catheterization following the echocardio-graphy confirmed the diagnosis of it as well as mitral stenosis, aortic regurgitation with stenosis, and tricuspid regurgiation. In addition, coronaryangiography disclosed the anomalous coronary ve-nous run. With these findings, the cause of embolic episodes was found to be due to the thrombus in the left atrium. In the surgery performed a ball thrombus of 40×35×36 mm and a mural thrombus of 15×35×20 mm in size in the left atrium were detected and removed, and both mitral and aorticvalves were replaced to artificial ones. She had a good hospital course after the surgery and dischar-ged without any complication. In this report, we discussed a case of left atrial thrombus observed in a combined valvular heart disease, with 29 lite-ratures reported in our country.