左肺全摘除術後縦隔変位例に対する僧帽弁手術の1例

Mitral Valve Surgery for a Patient with Mediastinal Shift after Left Pneumonectomy：Report of a Case

はじめに　左肺全摘除された患者では縦隔が左側背側に変位し，通常の手術視野と異なり，また健側肺のみで耐術が可能かの判断に迫られる．われわれは，左肺全摘除術後に縦隔変位を生じている弁膜症患者に対し，僧帽弁手術を行ったために報告する．

A 70-year-old patient who survived about 40 years after left pneumonectomy for tuberculosis visited emergency hospital, because of dyspnea. She received suitable medical therapy for atirial fibrillation and severe mitral regurgitation and hesitated heart surgery because of anxiety for surgical risk. The computed-tomography showed mediastinal shift to left and right lung compensatory expansion. Respiratory function test after treatment of heart failure showed only mild restrictive disorder. And the blood-gas examination in room air was 101 mmHg of Pao2 and 37 mmHg of Paco2. The mitral valve replacement was performed via median sternotomy and using normal cardiopulmonary bypass. And she fully recoverd without any respiratory complications. Mediastinal shift did not obstract the surgical view and establishment of cardiopulmonary bypass in this case. It seemed that the key of surgical successs is the preserved function of healthy residual lung.