右室腔へのミサイル塞栓の手術

Surgery for a Missile Embolus in the Right Ventricle

ミサイル塞栓1）または弾道塞栓症2）とは，弾道損傷によるまれな合併症である．ミサイル塞栓の発生は，低エネルギー発射体の不完全な血管内への貫通により起こる．その影響を受ける領域は損傷部位から離れているため，虚血や塞栓の診断が遅れる可能性がある．一般的に，心内異物とは心臓周囲もしくは心臓内部に存在する異物を総称する．原因は，医原性，自殺企図，外傷などさまざまなものが報告されている3）．

Ballistic embolism represents an unusual complication of vascular by a flying object injury. Because embolus is remote from injury site, the occurrence of missile embolus may be overlooked and lead to delay in diagnosis of significant ischemia or embolism. We herein report a successful surgical removal of a rare missile embolus from the upper arm in the right ventricle. A 44-year-old man visited our hospital because of pulsatile bleeding from the left upper arm due to injury by a flying metal fragment of a hammerhead. Chest roentgenogram and computed tomography （CT） scan 9 days after the injury demonstrated a missile embolus in the right ventricle, which was thought to be ballistic embolism of the metal fragment. We underwent surgical removal of the retained object under cardiopulmonary bypass uneventfully, and discharged home ten days later.