|
内容記述 |
成人期において肺動脈拡張(瘤)を認める症例は比較的希であり,併存心疾患,肺高血圧,血管炎,結合組織疾患の存在などを念頭におき精査を進める必要がある.肺動脈弁疾患を伴い,心機能改善を主目的として手術施行した2例の経験を報告する.症例1:54歳,女性.22歳時に肺動脈弁狭窄に対して交連切開術を受けていた.動悸を主訴に近医を受診し,精査で肺動脈拡張(60mm),肺動脈弁狭窄兼閉鎖不全,三尖弁閉鎖不全,発作性心房細動,慢性右心不全を認めた.手術は肺動脈弁置換(23mm生体弁),肺動脈縫縮,三尖弁輪縫縮,右房縫縮,右房MAZE手術を施行した.症例2:70歳,男性.労作時呼吸困難を主訴に近医を受診した.肺動脈の拡張(45mm)を指摘され当科に紹介された.精査で肺動脈弁狭窄,心室性不整脈を認めた.手術は肺動脈弁交連切開術,肺動脈縫縮術を施行した. Pulmonary artery (PA) aneurysm is rare, but its true incidence is unclear, because most cases remain asymptomatic. The need for surgical treatment is controversial. We report two cases of surgical treatment of PA aneurysm associated with pulmonary valve (PV) disease in adults. Case 1 : A 54-year-old woman. She underwent pulmonary valvotomy for pulmonary stenosis (PS) at age 22. She had suffered from palpitations and dyspnea on effort recently. Then progressive changes of pulmonary stenosis-regurgitation (PSR) occurred. After further examinations, she was diagnosed as having PA aneurysm and right ventricular dysfunction with PSR, tricuspid regurgitation and paroxysmal atrial fibrillation. We performed PV replacement, PA aneurysmo-plasty, tricuspid annuloplasty, cryo-MAZE procedure. Case 2 : A 70-year-old man sufferd recently from dyspnea on effort. The dilatation of the pulmonary artery was pointed out on chest X-ray. PA aneurysm and PS with ventricular arrhythmia were diagnosed. We performed PV commissurotomy and PA aneurysmo-plasty. There were no significant findings of high PA pressure in either case. PA with pulmonary valve disease in the presence of low pulmonary pressure have low risk of rupture and dissection. Surgical treatments are recommended when right ventricular dysfunction or ventricular arrhythmia secondary to pulmonary valve disease is present. |
110006632897.pdf (1.2 MB)
