口蓋扁桃・アデノイドの肥大によりうつ血性心不全をきたした3例

CONGESTIVE HEART FAILURE DUE TO HYPERTROPHIED TONSILS AND ADENOIDS, A REPORT OF THREE CASES

　I．はじめに

　口蓋扁桃・アデノイドの肥大によるうつ血性心不全の最初の報告は，竹沢^1）（1938）の1例と思われる。彼は呼吸困難・全身浮腫が口蓋扁桃摘出により消褪した症例を報告している。

　欧米では1965年にMenashe^2），Noonan^3）らの報告に始まり約60例の発表がある（第1表）。その多くは小児科医・外科医によるものであり，耳鼻科領域ではかかる現象は当然の理とするためか，あまり発表をみない。

　Since heart failure secondary to enlarged tonsils and adenoids was first elaborately described in 1965 by Menashe and Noonan, about 60 cases have been reported in various medical journals, especially in pediatric and otolaryngological fields.

　In this paper, 3 additional cases (1 year-old boy, 5 year-old girl, and 2 year-old boy) are reported in detail.

　Each case showed quite similar clinical course and was successfully treated by adenotonsillectomy. The EKG and chest-Xray examination revealed cardiomegaly with right atrial and venticular preponderance. Arterial blood gas examination showed obvious fall of Po₂ with rise Pco₂. The ENT examinations revealed hypertrophied tonsils an adenoids and very loud snoring at night.

　As these clinical symptoms were immediately relieved by adenotonsillectomy, the heart failure of these patients was thought to be caused by chronic nasopharyngeal airway obstruction. Therefore, it appears to be very important that ENT doctors pay attention to the possibility of cardiac complications in children affected with hypertrophic tonsils and adenoids.