内視鏡補助下の経大動脈弁的血栓摘除

Video-assisted Transaortic Left Ventricular Thrombectomy

左室内血栓は心筋梗塞後や心筋炎，心筋症などの合併症として生じるとされており，全身の塞栓症を引き起こすリスクとなる．可動性に富む血栓であったり，すでに塞栓症を生じているものに関しては外科的摘除の適応となるが，経左室的に摘除する方法が一般的であると思われる．しかしながら，経左室的摘除では左室壁の切開を伴い，術後の左室機能の低下などが危惧される．左室切開を回避するため，内視鏡を用いた経大動脈弁的または経

A 50-year-old woman visited a previous hospital because of aphasia. She was diagnosed as having cardiogenic embolism and left ventricular thrombus. Anticoagulant therapy was performed but was unsuccessful because of hypermenorrhea due to the myoma of the uterus. She was transferred to our hospital to receive surgical treatment. After uterine myomectomy, we performed video-assisted transaortic left ventricular thrombectomy. Her postoperative course was uneventful. Left ventriculotomy has been the standard approach for left ventricular thrombectomy. However, this approach carries a risk of ventricular dysfunction. We report our experience of a successful outcome with video-assisted transaortic left ventricular thrombectomy, thereby avoiding a left ventriculotomy.