Key result
Combined PTE with tricuspid repair successfully eliminates oxygen dependence in chronic thromboembolism.
Why the study?
Chronic pulmonary thromboembolism complicated by right atrial thrombus, atrial fibrillation, and tricuspid insufficiency is extremely rare and requires detailed surgical management.
Case Report (n=1)
No
Concomitant tricuspid annuloplasty and right-sided Maze procedure during pulmonary endarterectomy for chronic pulmonary thromboembolism with right atrial thrombus may contribute to stable postoperative hemodynamics and respiratory status.
May support feasibility of combined surgery in select chronic pulmonary thromboembolism cases; leaves open need for prospective validation.
きわめてまれな右房内血栓を合併した慢性肺動脈血栓塞栓症の手術例を報告する.症例は56歳,男性.慢性肺動脈血栓塞栓症に対して下大静脈フィルター挿入,ワーファリン内服,在宅酸素療法を行ったが呼吸苦が増悪した.心房細動を認め,心エコーで右心系の著明な拡大と右房内腫瘤,高度の三尖弁閉鎖不全症を認めた.造影CTでは右房内の血栓を疑う陰影と,肺動脈内の広範な血栓を認めたため手術を施行した.人工心肺を使用し心停止とし右房の陳旧性血栓を摘出,超低体温循環停止を併用して肺動脈内の血栓と肥厚した内膜を剥離摘除した.また三尖弁輪縫縮術,右側メイズ手術を同時に施行した.経過は良好であり在宅酸素療法を離脱した.三尖弁輪縫縮術,メイズ手術の同時施行は術中術後の循環,呼吸状態の安定に寄与したものと考える.
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浩司 et al. (2007) conducted a case report in Chronic pulmonary thromboembolism with right atrial thrombus, atrial fibrillation, and tricuspid insufficiency (n=1). Pulmonary thromboendarterectomy, right atrial thrombectomy, tricuspid annuloplasty, and Maze procedure was evaluated on Clinical recovery and hemodynamics. Pulmonary thromboendarterectomy combined with right atrial thrombectomy, tricuspid annuloplasty, and a Maze procedure successfully treated a patient with chronic pulmonary thromboembolism, allowing him to discontinue oxygen therapy.
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