心囊内血腫が原因と考えられた収縮性心膜炎の1例

Constrictive Pericarditis Associated with Pericardial Hematoma：Report of a Case

はじめに　収縮性心膜炎の原因として，感染症，開心術後，放射線照射後，腫瘍，自己免疫疾患など1）が報告されている．われわれは，心筋梗塞後の心囊内血腫が関与していると考えられた収縮性心膜炎例に対して外科治療を行ったので報告する．

A 59-year-old man was admitted to our hospital due to keto-acidosis. Electric cardiogram showed history of myocardial infarction. Cardiac echogram showed severe left ventricular hypokinesis, thickened pericardium and pericardial effusion. Right ventricular pressure curve showed dip and plateau pattern, and coronary angiography showed severe three vessel disease. So, we diagnosed with constrictive pericarditis accompanying pericardial effusion and ischemic heart disease. After cardiac catheterization, as the hemodynamics was getting worse, we inserted intraaoric balloon pumping （IABP） immediately and performed an emergent operation. The heart was compressed by hematoma and thickened pericardium. The surrounding tissue of hematoma was organized including fibrous tissue. We resected hematoma and pericardium, and the cardiac function was improved remarkably. His postoperative course was uneventful. The cause of hematoma was thought to be intrapericardial bleeding after cardiac infarction. He had cardiac tamponade and constrictive pericarditis, and the diagnosis of this case was considered to effusive constrictive pericarditis.