膵全摘術後に心停止を起こした肥大型心筋症の1例

Cardiac arrest episodes by cardiomyopathy following total pancreatectomy:a case report

　予定すべき手術が大きければ大きいほど心臓の術前評価は十分に行われるべきである。膵臓癌に対し膵全摘術を施行したあと2回の心停止を起こし，蘇生後巨大陰性T波へと移行し，肥大型心筋症と診断した。本症の心停止の原因および心電図変化を考えると，どうしても術前に予期し得ない本症のような心臓合併症もあり得ると考え報告する。

A 47-year-old man with advanced pancreatic car-cinoma underwent total pancreatectomy with resec-tion of the involved portal vein. His postoperative course was complicated by a couple of cardiac arrest episodes. The first episode occured seven weeks after surgery during drip infusion of CDDP, and later on during the thirteenth week after surgery. There was no apparent cause for those episodes. On both occasions resuscitation was performed ade-quately. The second arrest was followed by deep inverted T waves on ECG, however, not by eleva-tion of serum CPK-MB. Because of this, myocardial infarction was ruled out. The diagnosis of cardio-myopathy was made possible through the discovery on the echocardiogram of a hypertrophied left vent-ricle with thick interventricular septum. Then, on catheterization, myocardial squeezing in the left ante-rior descending coronary artery was noticed. Final-ly, histological findings concerning the biopsied car-diac muscle led to the same diagnosis. Cardiac arrest in this case seemed to be due to arrhythmia caused by cardiomyopathy. Echo cardiography should be routinely used as part of the examination prior to extended major surgery.