脳梗塞，腎梗塞を合併した慢性心房細動に対してRadial手術を施行した1例

A Case Report:Radial incision approach for chronic atrial fibrillation complicated by cerebral infarction and renal infarction

　脳梗塞に続いて腎梗塞を合併した慢性心房細動に対して，新しい心房細動手術法であるRadial手術を施行し，血栓除去と除細動に成功した症例を経験した．患者は62歳，女性．1998年6月近医で孤立性心房細動と診断されたが放置していた．同年9月脳梗塞で入院，内科的加療で後遺症なく軽快したが，超音波検査で左心耳内に血栓を認め，ワーファリンによる抗凝固療法を開始した．翌年1月左腎梗塞を発症し再入院，左腎は無機能となったが，右腎の機能は正常に保たれており，保存的に経過観察となった．心房細動に関しては，ワーファリン投与にもかかわらず塞栓症を繰り返し，再入院時にも左心耳内に血栓が認められたことから，外科的治療の適応と判断し，Radial手術を施行し，血栓除去と除細動に成功した．本手術は，従来のMaze手術に比して手技が簡便で，かつ術後の心房収縮能の改善に優れており，心房細動に対する新しい外科的治療法として期待される．

A patient with chronic atrial fibrillation experiencedcerebral infarction followed by renal infarction. Weemployed the radial incision approach, a new surgicaltechnique for atrial fibrillation, and succeeded ineliminating the thrombus and fibrillation. The patientwas a 62-year-old female who was diagnosed as havinglone atrial fibrillation, which the patient had neglected.Three months later, the patient was hospitalized forcerebral infarction, from which she recovered followingmedical treatment without any after effects. However,ultrasonography conducted at that time revealed athrombus in the left atrial appendage, so anticoagulanttherapy with Warfarin was initiated. Four months later,the patient was hospitalized again for left renal infarc-tion. While the left kidney had lost all functions, thefunction of the right kidney remained normal and thepatient was conservatively followed up by observation.With respect to atrial fibrillation, the administration ofWarfarin did not prevent recurrence of the embolism. Athrombus was detected again in the left atrial append-age upon re-hospitalization. Surgery was indicated andthe radial incision approach was performed. Theapproach succeeded in eliminating the thrombus andfibrillation. The new approach, compared with the con-ventional Maze method, is a simpler technique andpreserves the atrial contraction capacity postoperatively.The new technique is expected to become a new surgicaltreatment for atrial fibrillation.