興味ある心房交通を合併した三心房心症例

A Case of Cor Triatriatum Complicated with Absent Atrial Septum

　患者は28歳の女性．乳児期に心房中隔欠損症を指摘された。無症状にて経過していたが，20歳頃より動悸を自覚するようになった．28歳時，労作時息切れを主訴に当院を受診し，経胸壁心エコー検査にて左房内に左房との交通孔を有する異常隔壁を認め，三心房心と診断した．副心房と右房間および左房と右房間にも交通孔を有し，右肺静脈は右房に開口し，心房中隔欠損と肺静脈還流異常の合併を認めた．手術所見では，心房中隔欠損は全欠損型で，右肺静脈は左房に，左肺静脈は副心房に還流し，肺静脈還流異常の合併を認めなかった．三心房心は心房中隔や肺静脈還流異常を合併することも多く，その鑑別が重要となる．

We report a rare case of cor triatriatum complicated with absent atrial septum. A 28-year-old woman with short-breath on effort was admitted to our hospital. She was noticed to have an atrial septum defect (ASD) at her birth, but she had no symptom for about 20 years. Transthoracic echocardiography had demonstrated an abnormal septum with a fenestration in the left atrium, two defects in the atrial septum. and an anomalous right pulmonary venous connection to the right atrium. Preoperatively, we had diagnosed the patient as a case of cor triatriatum complicated with ASDs and partial anomalous pulmonary venous connections (PAPVC).However, during surgery, we found that there was an abnormal septum with two fenestrations in the left atrium and that she had no atrial septum. The accessory chamber received left pulmonary veins and the true left atrium received right pulmonary veins. We had misjud-ged her abnormal septum as being an atrial septum and had misdiagnosed her as PAPVC. Coy triatriatum can be complicated with other congenital anomalies, such as ASD or PAPVC. Preoperatively, it is important to diagnose correctly, so we report on our pre and post operative examinations of our differential diagnosis.