体位変換中に急性肺塞栓症を発症したと思われる切迫奇異塞栓症の1例

Impending Paradoxical Embolism with Acute Pulmonary Embolism during Postural Change；Report of a Case

はじめに　静脈系に発生した血栓が卵円孔開存（PFO）や心房中隔欠損を介して左房内に認められる状態を切迫奇異塞栓症（IPE）と呼ぶ．本例のような全身麻酔下体位変換に伴って急性肺塞栓症に併発したIPEの報告はほかになく，文献的考察を加え報告する．

A state in which thrombus is found in both right and left atria with thrombus penetrating the foramen ovale is called as impending paradoxical embolism （IPE）. A 42-year-old man was found to have poor oxygenation and shock when his body was turned prone after induction of anesthesia. We inserted percutaneous cardiopulmonary support （PCPS）, and his blood pressure was maintained. Transesophageal echocardiography revealed right heart pressure overload and left atrial thrombus. Computed tomography （CT） showed thrombosis in both main pulmonary arteries. The patient was judged to require emergency surgery. Bilateral pulmonary artery thrombus and thrombus between the right and left atria was removed under hypothermia using a heart-lung machine. Postoperatively, thrombus was detected in the bilateral posterior tibial vein and peroneal vein. He had a good postoperative course. There were few reports of IPE with pulmonary embolism that developed during operation.