心臓手術後の難治性胸水に対して横隔膜形成術および胸腔・腹腔シャント留置を施行した1例

Diaphragmatic Plication and Pleuroperitoneal Shunt Placement for Refractory Pleural Effusion After Cardiac Surgery：Report of a Case

はじめに　難治性胸水貯留により呼吸不全をきたした場合，頻回の経皮的穿刺を余儀なくされるため，患者の生活の質（QOL）は著しく低下する．われわれは三尖弁再置換術後の難治性胸水貯留および横隔神経麻痺による横隔膜挙上に対し，横隔膜形成術およびDenverシャント（ミハマメディカル社）を用いた胸腔・腹腔シャント造設術を行うことで良好な結果を得ることできたため，報告する．

When respiratory failure occurs due to intractable pleural effusion, frequent thoracentesis is necessary. We herein report a patient who underwent diaphragmoplasty and pleuroperitoneal shunt for refractory pleural effusion after cardiac surgery. The patient was an 82-year-old man with a history of tricuspid valve replacement for tricuspid regurgitation 9-years ago. Heart failure recurred due to prosthetic valve dysfunction, and he underwent repeat tricuspid valve replacement. Postoperatively, he had right diaphragmatic nerve palsy and required frequent thoracentesis for persistent dyspnea on exertion and pleural effusion. He underwent thoracoscopically-assisted right diaphragmatic plication and right pleuro-peritoneal shunting using a Denver shunt. Dyspnea subsided, and pleural effusion disappeared. Diaphragmatic plication and pleuro-peritoneal shunting using a Denver shunt for refractory pleural effusion with diaphragm elevation may improve patient’s quality of life.