肺左上葉切除後の遺残左上肺静脈断端に起始する左房内血栓を切除した1例

Surgical Removal of Left Atrial Thrombus Originating from the Left Upper Pulmonary Vein Stump after Left Upper Lobectomy；Report of a Case

はじめに　肺葉切除後の左房内血栓症は比較的まれであるが，患者側の因子のみならず，肺葉切除術の術式により発生率が異なる可能性が指摘されている．特に左上葉切除後に残る左上肺静脈断端での血栓形成が多くみられる1）．われわれは肺左上葉切除後の遠隔期に，左房内に肺静脈断端部から起始する血栓を認め，血栓摘除および左上肺静脈断端切除を行った症例を経験したので報告する．

Left upper lobectomy may be a risk factor for thrombosis in the pulmonary vein stump. We report a case of surgical removal of a left upper pulmonary vein stump thrombus after left upper lobectomy. A 73-year-old man with transit ischemic attack had a history of left upper lobectomy for pulmonary tuberculosis 40 years before. Echocardiography and chest computed tomography （CT） scan revealed a mobile thrombus in the left atrium originating from the left upper pulmonary vein stump. Surgical removal of the thrombus as well as the left upper pulmonary vein stump was performed under extracorporeal circulation and cardioplegic cardiac arrest. Pathological examination of the pulmonary vein stump revealed no growth of tumor nor injury of endothelial cells. Postoperative course was uneventful and no recurrence of the thrombus was observed during 7 years after surgery.