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Kokyu to Junkan Volume 43, Issue 8 （August 1995）

呼吸と循環 43巻8号（1995年8月発行）

Japanese English

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症例

右室流出路および肺動脈主幹部の狭窄を合併した急性解離性大動脈瘤の1例 Compression of Right Ventricular Outflow and Main Pulmonary Artery due to Acute Dissecting Aortic Aneurysm 野原千洋子 ¹ , 加納達二 ¹ , 粕谷秀樹 ¹ , 山﨑明 ¹ , 小林清亮 ¹ , 渡邊隆 ² , 笹栗志郎 ² , 忽滑谷通夫 ² , 細田泰之 ² Chiyoko Nohara ¹ , Tatsuji Kanoh ¹ , Hideki Kasuya ¹ , Akira Yamasaki ¹ , Seiryou Kobayashi ¹ , Takashi Watanabe ² , Shirou Sasaguri ² , Michio Nukariya ² , Yasuyuki Hosoda ² ¹順天堂大学医学部附属順天堂浦安病院内科 ²順天堂大学医学部胸部外科 ¹Department of Internal Medicine, Juntendo Urayasu Hospital Juntendo University ²Department of Thoracicsurgery, School of Medicine, Juntendo University キーワード：急性解離性大動脈瘤 , 肺動脈閉塞 , 人工血管置換術 , acute dissecting aortic aneurysm , occlusion of the pulmonary artery , an artifical graft Keyword: 急性解離性大動脈瘤 , 肺動脈閉塞 , 人工血管置換術 , acute dissecting aortic aneurysm , occlusion of the pulmonary artery , an artifical graft pp.825-830

発行日 1995年8月15日 Published Date 1995/8/15

DOI https://doi.org/10.11477/mf.1404901107

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　症例は53歳，女性．1993年5月30日，突然の胸・背部痛，呼吸困難出現後，ショックおよび多臓器不全の状態で入院．心エコーで左室肥大・左室機能障害，高度の三尖弁閉鎖不全症を認めた．持続血液濾過療法などの治療により軽快をみたが，経過中胸水再貯留を来し，心エコー再検時新たに右室流出路を圧排する腫瘤を認めた．CT,MRI，および心血管造影検査で上行大動脈の前壁中部にエントリーを有する腕頭動脈分岐直前までの上行大動脈全長に広がる解離性大動脈瘤（De Bakey II型）および縦隔内血腫の合併を確認した．急性期内科的治療を行い，慢性期人工血管置換術を施行，経過良好で入院から約7ヵ月で軽快退院し現在通院治療中である．以上極めて稀な右室流出路および肺動脈主幹部の狭窄を合併した急性解離性大動脈瘤の治療に成功した1例を経験したので報告する．

A 53-year-old female was admitted with an abrupt onset of chest pain, back pain and shortness of breath On arrival at the hospital MOF (multiorgan failure) and hypotension appeared. Echocardiogram showed left ventricular hypertrophy, left ventricular dysfunc tion and severe tricuspid regurgitation. A 99mTC macroaggregated albumin lung scan did not reveal perfusion defect of the lung. She was treated with CHF (continuous hemofiltration) and medication. Thesetreatments demonstrated improvement. But after a while, a chest X-ray showed pleural effusion again and echocardiogram showed mass which compressed right ventricle anew. Thoracic Computed Tomography (CT), Thoracic Magnetic Resonance Imaging (MRI) and Cardiac cathetherization were undergone. They disclosed dissection of the ascending aorta (De Bakey type II) with a large adventitial hematoma which extended from the ascending aorta after medial rupture of the aortic dissecting anurysm, and continuous hematoma which extended from this adventitial hematoma after adventitial rupture. By this hematoma outflow of right ventricle and main pulmonary artery was compressed. In this case CHF and medication were undergone immediately and after about 6 month the ascending aorta were replaced with an artifical graft successfully. She discharged from the hospital within a month after the operation.

The occulusion of right ventricular outflow and pul-monary artery by an acute dissecting aneurysm is a rare complication. In such cases. the correct diagnosis and prompt treatment is necessary. But these cases were often made wrong diagnosis, acute massive pulmonary embolism. We reported one case who was treated successfuly. Such is the purpose of this report.