内視鏡補助下に切除した左室流出路に発生した乳頭状線維弾性腫の1例

Resection under Endoscopic Guidance of Papillary Fibroelastoma in the Left Ventricular Outflow Tract：Report of a Case

はじめに　乳頭状線維弾性腫（PFE）は良性腫瘍であり1），発生時は好発する大動脈弁1～4）に弁機能温存の目的で単純切除が推奨されている5）が，近年では再発例も散見される2，6，7）．特に無症状で診断された際の手術では，不完全切除を回避すべく確実な外科的切除と，弁などの機能温存の両面が求められる．

A 76-year-old man was admitted to our hospital for a thorough examination of a suspected cardiac tumor on transthoracic echocardiography. Transesophageal echocardiography demonstrated a 9.4×8.1 mm mobile stalk-like mass in the left ventricular outflow tract. A preoperative electrocardiogram revealed paroxysmal atrial fibrillation. Tumor resection and pulmonary vein isolation were performed to prevent embolism and confirm the diagnosis. The tumor was resected using an endoscope because it was difficult to evaluate the tumor under direct view from the aortic valve. Pathological diagnosis was cardiac papillary fibroelastoma. Postoperative echocardiography showed no residual tumor or aortic regurgitation. One year and eight months passed since the surgery, and no recurrence of the tumor was detected. In cases like this one, where direct observation of the tumor is difficult, we suggest that the use of an endoscope may be effective because it has the advantage of sharing information with other surgeons.