拡張型心筋症患者に発症した心原性脳塞栓症に対する低侵襲外科的左心耳閉鎖術

Less Invasive Surgical Closure of the Left Atrial Appendage for Cardiogenic Cerebral Embolism in a Patient with Dilated Cardiomyopathy

心原性脳塞栓症（CCE）の多くは心房細動（Af）に合併して発症するが，その血栓の9割は左心耳で形成される1）．また，非弁膜症性心房細動（NVAF）によるCCEの発症リスクは左心耳の拡大と相関することが報告されている2）．

Less invasive surgical closure of the left atrial appendage is recommended to prevent cardiogenic thromboembolism in patients with chronic non-valvular atrial fibrillation （Af） and other high-risk cardiac diseases such as dilated cardiomyopathy （DCM）. We report a case of a 57-year-old man with Af and DCM. Catheter ablation for Af was contraindicated in this patient with a history of cardiogenic thromboembolism, and anticoagulation therapy was initiated. Despite anticoagulation therapy, the patient developed another ischemic stroke and we administered aggressive anticoagulation therapy resulting in successful resolution of the left atrial appendage thrombus. Less invasive surgical closure of the left atrial appendage was successfully performed, and thromboembolism has not recurred for one year postoperatively.