PTCA 7日後に多発性肺塞栓症を発症し，右房内に浮遊血栓を認めた1例

A Case of Multiple Pulmonary Elnbolism with Floating Right Atrial Throlnbus after PTCA

　症例は46歳，男性．1997年7月23口不安定狭心症にて入院となる．同日CAGにてLCXに高度狭窄を認めステントを留置し症状は軽快した。9月3日にLADに対しPTCAを試みるも不成功であった．9月10日夕突然ショック状態となり，心エコーでは右室負荷所見および右房内を旋回する血栓様エコーを認め，肺塞栓症が疑われた．抗凝固療法，血栓溶解療法を開始し臨床所見はやや改善した．翌日の肺血流シンチでは両側に多発性の欠損像を認め，心エコーでは血栓像は残存しており手術を施行した．術中肺動脈本幹から両側肺動脈にかけて多数の血栓を認めたが，右房壁は平滑で血栓は認めず血栓は未梢静脈由来のものと考えられ，多量の血栓を吸引し血行動態は安定した．PTCA数日後にも肺塞栓を合併することがあり，可動性の血栓を右房内に認める例は致死性の肺塞栓症に至る可能性が高いため手術を念頭においた治療方針の選択が必要であると考えられた．

A 46 year-old male was admitted to our hospital due to unstable angina on July 23, 1997. Coronary interven-tion to LCX was perfumed. On September 3. PTCA to LAI) was carried out but these was unsuccessful.

On the evening of August 10, the patient suddenly experienced difficulty in breathing and fell into shock. Right heart dilatation and a floating thrombus in the right atrium were observed in two-dimensional echogra-phy, so pulmonary embolism was diagnosed. His symp-toms and clinical state improved after anti-coagulation and thrombolysis. But lung perfusion scintigram revealed bilateral massive multiple defects and the floating right atrial thrombus still remained on two-dimensional echocardiography. Surgical thrum-bolectomy was performed, because it was highly pos-sible that lethal pulmonary embolism would occur. AA large quantity of thrombus was observed at the trunk ol the pulmonary artery and bilateral pulmonary arteries. The absence of thrombus on the right atrium and smooth right atrial wall suggested that it was embolized from peripheral veins. Pulmonary embolization often occurs repetitively, and the right atrial thrombus is actually due to the pulmonary embolism. It is necessary to select a therapeutic course with the need for surgical therapy in mind.