出血性脳梗塞を伴う巨大左房粘液腫摘出術

Giant Left Atrial Myxoma Complicated with Hemorrhagic Cerebral Infarction

左心系粘液腫は30～40％に脳血管障害を合併する1）．広範囲脳梗塞や出血性脳梗塞の発症後急性期における開心術は神経症状悪化の原因となりうるため，手術時期については個々の症例に応じる必要がある．われわれは，出血性脳梗塞に伴う巨大左房腫瘍に対して，発症後急性期に腫瘍摘出術を施行した1例を経験したので報告する．

A 48-year-old woman developed paralysis of the left upper limb and dysarthria. Two days later, she was admitted to a local hospital due to no improvement of symptoms. Brain magnetic resonance imaging showed acute hemorrhagic cerebral infarction in the left nucleus basalis. Echocardiography demonstrated a large left atrial mass in the left atrium, shuttling between the left atrium and the left ventricle and moderate mitral regurgitation. Then, she was transferred to our hospital for surgery. Five days after the initial symptoms, resection of the left atrial mass was performed under total cardiopulmonary bypass. First, heparin sodium, and then nafamostat mesilate were used as intraoperative anti-coagulation treatment. The left mitral mass was removed via an atrial septal incision and the defect was repaired using a bovine pericardium. The mitral valve was intact and there was no regurgitation. The mass was immunohistologically diagnosed as myxoma. Postoperative brain computed tomography scans demonstrated no exacerbation of the cerebral infarction. She was discharged 13 days after surgery without neurological symptoms.