多臓器障害を呈した冠状動脈バイパス術後収縮性心膜炎

Constrictive Pericarditis with Multiple Organ Failure after Coronary Artery Bypass Grafting

開心術後の収縮性心膜炎（CP）はまれではあるが，よく知られた合併症である．心膜切除術が施行されるが，手術成績・長期予後ともにいまだ満足できるものではない1～4）．われわれは，長期間の保存的治療で多臓器障害を呈したが，心膜切除術により良好な遠隔予後を得た1例を経験したので報告する．

A 67-year-old male patient, who had undergone coronary artery bypass grafting （CABG） 16 years before, developed congestive heart failure 5 years after surgery. Three years later, he developed repeated heart failure, sepsis by methicillin-resistant Staphylococcus aureus （MRSA）, renal failure, repeated thrombophlebitis on his right leg and atrial fibrillation. He also suffered from clouding of consciousness and flapping tremor caused by hyperammonemia. The three bypass grafts showed normal flow, but the pericardium was severely thickened. Therefore, pericardiotomy was performed via median sternotomy with additional left thoracotomy without using cardiopulmonary bypass. Although, he developed MRSA mediastinitis after surgery, he recovered after a month of continuous negative pressure wound therapy. His liver function and septic conditions gradually recovered. No recurrence of heart failure has been observed for 8 years since his second surgery.