左室内血栓除去術を施行した脳塞栓合併拡張型心筋症の2例

Left Ventricular Thrombectomy in Patients with Dilated Cardiomyopathy Accompanied by Cerebral Embolism：Report of Two Cases

はじめに　左室内血栓（LVT）は，虚血性心疾患（IHD），拡張型心筋症（DCM），心筋炎などで起こるとされているが，DCMの割合は少ない1）．われわれは，DCMによるLVTから脳塞栓を発症し，急性期に血栓除去術を施行した2例を経験したので報告する．

Left ventricular thrombus （LVT） formation is a known complication of ischemic heart diseases including acute myocardial infarction, dilated cardiomyopathy （DCM） and myocarditis. Among them, few cases involve DCM. Two DCM patients with LVT developed acute cerebral infarction and underwent thrombectomy. Both patients presented with sinus rhythm and neither had previous thromboembolic event. However, their transthoracic echocardiography （TTE） showed left ventricular ejection fractions＜35％ and left ventricular diastolic diameters≧60 mm, indicating high possibilities of LVT formation. The TTE findings suggest that DCM patients require anticoagulation therapy and frequent imaging examination, even with sinus rhythm and no history of thromboembolic events. Once a thromboembolic event occurs, thrombectomy is urgently needed.