低侵襲僧帽弁形成術中に起きた対側緊張性気胸の1症例

A Case of Contralateral Tension Pneumothorax during Minimally Invasive Mitral Valvuloplasty

要旨

　右小開胸での低侵襲僧帽弁形成術中，右胸腔ドレーンを留置し閉胸する際，重度の酸素化不良と血圧低下を認め，透視撮影で左肺野透過性亢進と心臓の右側偏移から左緊張性気胸と診断した。左胸腔ドレーンを留置したところ病態は回復した。胸腔ドレーン挿入は対側気胸を起こすことがあり，透視は術中気胸の迅速な診断の一助となる。

　During a minimally invasive mitral valvuloplasty via a right mini-thoracotomy for an adult male, severe deoxygenation and hypotension occurred following the insertion of a chest drain in the right thorax and wound closure, and we diagnosed left-sided tension pneumothorax based on our observation of hyperlucency on the left side of the thorax and heart deviation toward the right. Placing a left chest drain improved the deoxygenation and hypotension. Occasionally, a chest drain in the thorax can result in contralateral pneumothorax, for which radioscopy can be a useful diagnostic tool.