経右房・肺動脈アプローチによる右室二腔症修復術を施行した1例

Surgical Repair without Ventriculotomy for Double-chambered Right Ventricle in a 61-year-old Man；Report of a Case

はじめに　成人における右室二腔症（DCRV）の症例はまれながらもいくつかの報告が散見される．本邦における成人症例において，手術でのアプローチ方法が明記されている報告のほとんどが右室切開によるものであった．なかには右室切開に伴い，術後不整脈や右室障害の要因となった症例もある．

A 61-year-old man with double-chambered right ventricle （DCRV） was operated on successfully without ventriculotomy. The patient presented with cardiac murmur and electrocardiogram abnormality with exertional dyspnea. Echocardiography demonstrated double-chambered right ventricle with severe tricuspid valve regurgitation. Cardiac catheterization data revealed a 110 mmHg peak-to-peak pressure gradient in the right ventricular cavity with normal pulmonary pressure. The tricuspid valve was repaired with an annuloplasty ring, and the abnormal muscle bands in right ventricular outflow tract were resected through both right atrium and pulmonary artery. No major complications occurred after surgery. Postoperative echocardiography demonstrated a pressure gradient of 18 mmHg between the pulmonary artery and right ventricle without tricuspid regurgitation, and his clinical symptoms were improved. Surgical repair without right ventriculotomy combined with tricuspid annuloplasty was effective and feasible for DCRV in an adult patient.