三心房心を伴った多発性脳梗塞の1例

A Case of Multiple Cerebral Infarction Accompanied by a Cor Triatriatum

　Ⅰ．はじめに

三心房心は結合織や筋組織よりなる先天性の隔壁によって左心房が2分される，全先天性心疾患のわずか0.1％を占める稀な先天性疾患である．三心房心は軽症の場合，無症候性あるいは僧帽弁狭窄症類似の症状を呈し，時に塞栓症を発症することがある^1-3,6)．

　われわれは，頭蓋骨形成術中に多発性脳梗塞を発症し，術後に経食道心エコーによって無症候性の三心房心を発見した非常に稀な症例を経験した．本例の三心房心と多発性脳梗塞の因果関係を検討し，三心房心について文献的に考察する．

　A cor triatriatum is a congenital malformation of the heart which,in almost all cases,is diagnosed in childhood,whereas adult cases are very rare. The hemodynamics of the cor triatriatum is similar to that of mitral stenosis,which sometimes,but rarely,causes embolism. We present a case of multiple cerebral infarctions accompanied with a cor triatriatum. A 57-year-old female suddenly displayed impaired consciousness and hemiparesis immediately after cranioplasty for another disease,and was diagnosed by a diffusion weighted MRI as having multiple infarctions. A transesophageal echocardiography detected a membrane-like,echo-dense structure across the left atrium,suggesting a cor triatriatum. We suspect that her multiple infarctions were caused by embolism due to a cor triatriatum. Here,we discuss the relationship between her embolic stroke and the cor triatriatum,with references to literature on the subject.