123I-BMIPP心筋シンチグラムにて病態評価しえた周術期心筋傷害の1例

Post-operative Myocardial Damage Assessed by Cardiac Scintigram using 123I-β-Methyl Iodophenyl Pentadecanoic Acid

　今回われわれは，周術期の低血圧による心筋傷害例を経験し，¹²³I-β-methyl iodophenylpentadecanoic acid心筋シンチグラム（以下BMIPP）にて経時的に病態評価しえたので報告する．症例は81歳，女性．腸閉塞に対する開腹手術中に低血圧を来し一過性の心電図上のST上昇，左室心尖部を中心とした広い領域に壁運動低下を認め，同部位にBMIPPの高度集積低下をみた．血行動態は早期に改善し，心電図所見と壁運動は2カ月後に正常化，BMIPP所見は1年の経過で著明な回復を認めた．本症例は冠動脈病変はなく，低血圧に伴う心筋灌流低下による可逆的心筋傷害と考えられた．以前より手術を誘因とする可逆的心筋傷害については報告されているが，心筋脂肪酸代謝異常の回復様式についてはよく知られていないのが現状である．本症例では早期の冠血流の改善によって，慢性期の心筋脂肪酸代謝の正常化が期待できると考えられた．

We reported a case of an 81-year-old woman witf post operative myocardial damage due to hyptotensior assessed by cardiac scintigram using ¹²³I-,3-methyl iodo phenyl pentadecanoic acid (BMIPP). In 1994, the patient had an operation for intestinal ileus. The elec trocardiogram monitor revealed a transient ST eleva tion during the operation after blood pressure had fallerbelow 60 mmHg. The echocardiogram showed hypo-kinetic motion of the wall in the broad region around the left ventricular apex, in which BMIPP tracer uptake had also markedly decreased. After a few hours, systolic blood pressure was kept above 100 mmHg and the hemodynamic findings were normalized. The ail-ments found by the electrocardiogram and the echocar-diogram had recovered in two months. It took about 1 year for BMIPP tracer uptake to be completely normal-ized. This case without organic coronary artery stenosis was thought to have reversible myocardial damage due to the decrease in the flow of myocardial perfusion associated with hypotension. Thus the BMIPP tracer uptake improved following wall motion normalization because of early coronary reperfusion. Although there are many reports on postoperative acute reversible myocardial damage, we could not find any report on cardiac fatty acid metabolic recovery in such cases.

This case suggested that earlier reperfusion of coro-nary artery flow was important for cardiac fatty acid metabolic recovery in the chronic phase.