腹腔鏡下胆囊摘出後にたこつぼ型心筋症を発症した1例

“Takotsubo” cardiomyopathy after laparoscopic cholecystectomy : A case report

症例は79歳，女性．胆石症にて入院した．術前心電図，心臓超音波検査は正常範囲内であった．全身麻酔下に腹腔鏡下胆囊摘出術を施行し，麻酔の導入，手術，覚醒ともに問題なく終了した．第1病日にモニター上T波陰転が出現し，患者の自覚症状は特になかった．12誘導心電図ではⅠ，Ⅱ，aVL，V2～6で陰性T波を認めた．心臓超音波検査では左室心尖部の壁運動の低下，バルーン状拡張を認め，たこつぼ型心筋症と診断した．壁運動低下の範囲は小さく，また循環動態も安定しており経過観察とした．術後1か月後の心臓超音波検査では左室壁運動の改善を認めた．本症の誘因の1つに消化器外科手術が挙げられ，外科医にとって注意しなければならない術後合併症の1つである．

　A 79-year-old woman was admitted to our hospital for surgical treatment of gall stone. Physical examinations, preoperative electrocardiography and echocardiography revealed no major findings. Thus we performed a laparoscopic cholecystectmoy under general and epidural anesthesia. There was no trouble throughout the operation. A day after the surgery, electrocardiographic monitor showed negative T wave in lead Ⅱ. We also confirmed negative T wave in leads Ⅰ, aVL and V2-6 at the same time. Since echocardiography revealed apical akinesis and ventricular wall dilation like a balloon, a diagnosis of so called “takotsubo” cardiomyopathy was made. Because cardiac function was good, she was carefully obsereved without drugs. The left ventricular motion improved to almost normal level within the next 4 weeks. Nine months after the operation, she is free from the disease. It is considered that stress, blood transfusion, hemodialysis, endoscopic examination and gastrointestional surgery may cause “takotsubo” cardiomyopathy. Therefore, it is importanat to have this disease in mind and to be able to recognize in when necessary.