左室心尖部の乳頭状線維弾性腫に対する小切開右開胸アプローチによる摘出術

Excision of a Left Ventricular Papillary Fibroelastoma via Right Thoracotomy with a Small Skin Incision

乳頭状線維弾性腫は，粘液腫に次いで2番目に多い心臓良性腫瘍である1）．その多くは弁葉や弁輪などの弁組織に発生し，心腔内に発生するものはまれである2，3）．われわれは，可動性を有する左室心尖部の乳頭状線維弾性腫に対する皮膚小切開下の右肋間開胸，いわゆる低侵襲心臓手術（MICS）による腫瘍摘出術を経験したので，若干の文献的考察を加えて報告する．

A 75-year-old woman was referred to our hospital for surgical treatment of a left ventricular mass. Echocardiography demonstrated a mobile left ventricular mass originating from the apex of the anteroseptal wall. Cardiac magnetic resonance imaging showed low signal intensity on T1 images and high signal intensity on T2 images. A right 4th intercostal thoracotomy with a small skin incision was performed, and cardiopulmonary bypass was established via the right femoral artery and vein and the right jugular vein. After cardiac arrest, we approached the tumor through the mitral valve via a left atrial incision. Resection of the tumor was difficult owing to its deep location；however, we could successfully resect it using an endoscope. Histopathological diagnosis confirmed a papillary fibroelastoma. Postoperative course was uneventful. A papillary fibroelastoma originating from the left ventricular wall is rare. Although a right thoracotomy is a useful approach for the management of a cardiac mass, careful planning is needed to obtain access to a mass in deep location.