心房細動に合併した心房拡大に対する広範囲両心房切除術

Extensive Atrial Resection for Marked Atrial Enlargement due to Long-standing Persistent Atrial Fibrillation

著明な心房拡大を伴う持続性心房細動例では，肺高血圧症に加えて拘束性換気障害を合併していることがしばしばあり，弁膜症手術のみでは術後に息切れ症状が残存する可能性がある．われわれは持続性心房細動に伴う両心房拡大例に対し，弁膜症手術とmaze手術に加えて広範囲心房切除術を施行し，良好な経過を得た1例を経験したので報告する．

A 67-year-old female, diagnosed with atrial fibrillation over 35 years ago, presented with mild heart failure symptoms. However, due to mild mitral regurgitation, she had been managed conservatively at local hospital. Recently, she developed severe dyspnea and was referred to our institution for surgical intervention. Comprehensive evaluation revealed significant enlargement of both atria, leading to a restrictive ventilatory impairment. The surgical procedure included mitral annulus repair, tricuspid annulus repair, maze procedure, and extensive cylindrical resection of the left atrium, along with right atrial repair, all performed under cardiopulmonary bypass. Post-surgery, her atrial volume decreased from 830 ml to 275 ml, and her vital capacity improved from 1.28 l to 1.77 l. Following the procedure, she maintained sinus rhythm, with complete resolution of her dyspnea. These improvements have been sustained for three years postoperatively.