急性左心不全で発症した左房粘液腫の1例

A Case of Left Atrial Myxoma Presenting with Acute Left Heart Failure

　腫瘍による僧帽弁閉塞のためショック状態となった左房粘液腫に対し，緊急手術を施行し救命しえたので報告する．症例は70歳，男性．突然の呼吸困難，意識消失にて近医受診．急性肺水腫と診断され気管内挿管のもと呼吸，循環管理が行われた．心エコー検査にて左房内に巨大な腫瘤が確認され，当科転科となった．当科転科時には意識は清明，四肢麻痺もないことから，同日緊急手術を施行した．腫瘍は心房中隔より発生し，巨大かっ広基性であったため，心房中隔と一塊にして腫瘍を切除し，欠損部はダクロンパッチで閉鎖した．摘出した腫瘍は75×60×30mm,105gで組織学的には粘液腫であった．術後経過は良好で，現在術後1年を経過したが，再発なく健在である．本症例ではショック状態となるまで腫瘍の存在に全く気付かれておらず，ショック状態となった際の迅速かつ適切な処置により救命することができた非常に幸運な症例であった．

We encountered a case of left atrial myxoma present-ing with acute heart failure. A 70-year-old man wasadmitted to a nearley hospital due to sudden onset of severe dyspnea. He was in cardiogenic shock with pul-monary edema and was diagnosed, by two-dimensional echocardiography, as having a left atrial tumor. He was then transferred to our hospital and an emergency operation was performed on the same day. Under car-diopulmonary bypass, the tumor was resected along with the atrial septum to which it was attached. The tumor was 75mm×60mm×30mm in size and 105g in weight and pathologically, it showed typical findings of myxoma. The postoperative course was uneventfull and the patient is doing well with no local recurrence 1 year after operation. Thus, a good result was obtained by excision of the tumor. Surgery should be considered as early as possible in patients undergoing cardiogenic shock.