寺師 利彦¹, 薗田 正浩¹, 川畑 和代¹, 塗木 徳人¹, 福岡 嘉弘¹, 山下 英世¹, 山王 和寿¹, 田中 康博¹, 真田 純一², 有馬 暉勝¹

Toshihiko TERASHI¹, Masahiro SONODA¹, Kazuyo KAWABATA¹, Norihito NURUKI¹, Yoshihiro FUKUOKA¹, Hideyo YAMASHITA¹, Kazuhisa SANNOU¹, Yasuhiro TANAKA¹, Jun-ichi SANADA², Terukatsu ARIMA¹

¹鹿児島大学医学部第二内科, ²鹿児島県立大島病院循環器科

¹Department of Second Internal Medicine, University of Kagoshima Faculty of Medicine, 8-35-1 Sakuragaoka, Kagoshima-shi, Kagoshima-ken 890-8520, Japan, ²Division of Cardiology, Kagoshima Prefectural Ohshima Hospital, 18-1 Manatsu-cho, Naze-shi, Kagoshima-ken 894-0015 , Japan

キーワード : Acute myocardial infarction , Coronary embolism , Left atrial myxoma

Coronary arterial embolization is an extremely rare and potentially lethal complication of atrial myxomas. A 61-year-old male patient was admitted on 3 April 1997 for chest pain accompanied by cold sweat and dyspnea after he had pruned trees in his garden. ST segment elevation in leads II, III, and aVF was indicated by electrocardiogram (ECG) at time of admission, and an echocardiogram showed severe hypokinesis of inferior-wall motion and a mobile tumor in the left atrium; however, emergency coronary angiography showed no significant finding, and there was no ST elevation in the ECG during the catheter examination. Further, the patient recalled having had severe lassitude of the legs in 1995 and 1996, and because systemic embolization, a common complication of this disease, suggested arterial embolization of the legs, he was assumed to have had an acute myocardial infarction caused by coronary embolism from the left atrial myxoma, which reperfused before the coronary angiography was conducted. A 40×40×30-mm tumor that protruded from the interatrial septal wall to the left atrium was surgically removed on 30 April 1997. Histologic examination of this tumor confirmed as a myxoma.