右胸心と下大静脈欠損を合併した僧帽弁閉鎖不全症兼三尖弁閉鎖不全症

Mitral Valve and Tricuspid Valve Regurgitation in a Patient with Dextrocardia and Absence of the Inferior Vena Cava

位置異常心臓では心奇形を伴うことが多い．もっとも単純な型である鏡像型右胸心は心奇形の合併が比較的少ないとされるが，それでも正常位心臓より多い．したがって術前診断は正確でなければならず，特に大血管系の術前評価は体外循環確立においてきわめて重要である．われわれが経験した右胸心と下大静脈欠損を合併した僧帽弁閉鎖不全症（MR）・三尖弁閉鎖不全症（TR）・心房細動（Af）に対する僧帽弁形成（MVP）・三尖弁形成（TAP）・maze手術例を，若干の文献的考察を加えて報告する．

Dextrocardia is a rare condition frequently associated with multiple and complex cardiovascular abnormalities. A 66-year-old woman, who had been diagnosed with dextrocardia at young age, was referred to our hospital with complaint of increasing dyspnea. Severe mitral regurgitation, moderate tricuspid regurgitation, and atrial fibrillation were detected. The multi detector-row computed tomography （MDCT） revealed absence of the inferior vena cava, and the hepatic vein connected directly with the right atrium. The venous cannulae were inserted into the superior vena cava directly and into the hepatic vein from the right atrium. Mitral valve repair, tricuspid valve repair, and maze procedure were successfully performed. MDCT is useful for detecting abnormality of vena cava in a cases of dextrocardia.