難治性腹水を合併した大動脈弁置換術後収縮性心膜炎の1例

Constrictive Pericarditis with Intractable Ascites after Aortic Valve Replacement；Report of a Case

収縮性心膜炎は下肢浮腫，肝腫大，腹水貯留などの右心不全症状を呈するが，胸痛や呼吸苦といった心疾患の特異的所見に欠けることが多い．また開心術後の発症頻度は非常に少ないため，診断に苦慮することが多い1）．われわれは開心術後収縮性心膜炎により難治性腹水をきたした症例に対し，外科的治療で良好な結果を得たので報告する．

We report a 68-year-old man, who developed refractory ascites of unknown cause after aortic valve replacement. He was diagnosed with constrictive pericarditis because of “dip-and-plateau” waveform findings via cardiac catheterization and operated with cardiopulmonary bypass. Following waffle procedure, we incised pericardium for decompression, so that pericardial mobility and diastolic dysfunction was improved. Postoperative computed tomography （CT） image also showed decrease of ascites fluid. We concluded that pericardiotomy is an established surgical procedure and is excellent indication to constrictive pericarditis.