多臓器機能不全を伴う収縮性心膜炎再発に対する手術

Re-operation for Recurrent Constrictive Pericarditis with Multiple Organ Dysfunction

収縮性心膜炎（CP）は，結核が減少した現在では頻度が少なく，他方縦隔への放射線照射や心臓手術後の発症が増加している．本疾患に対する外科的治療は心膜剝皮術であり，その際には下大静脈周囲を含む右房・右室の十分な心囊膜切除が重要である．さらに臓側心膜も十分切除しなければ手術の効果が得られない．左室後壁を取り囲む石灰化を有する場合は，これに対しても十分に切除を行わなければ，左室流入障害をきたす．われわれは心膜剝皮術10年後にCPが再発し，高度右心不全をきたした例に対して，残存する右室流入路および左室側の再心膜剝皮術を行い，良好な結果を得たので報告する．

The patient was a 64-year-old man with recurrent constrictive pericarditis which developed 12 years after the initial pericardiectomy. He had bilateral heart failure with severe left ventricular diastolic dysfunction, massive ascites, renal failure, and coagulopathy. Computed tomography showed a heavily calcified pericardium around the right atrium, the phrenic side of the right ventricle, and the left ventricle. He underwent pericardiectomy via median sternal re-entry. The calcified pericardium was safely decorticated with an ultrasonic surgical knife. The pericardium around the left ventricular side was safely decorticated under cardiopulmonary bypass and use of a heart positioner. Although permanent hemodialysis was necessary after the operation, he has been well for 6 years since the operation.