安部 啓介¹, 片野 浩¹, 安藤 輝彦², 安藤 浩巳², 石川 博敏³, 外山 雅章⁴, 堀見 洋継⁵, 田村 裕男²

Keisuke ABE¹, Hiroshi KATANO¹, Teruhiko ANDOH², Hiromi ANDOH², Hirotoshi ISHIKAWA³, Masaaki TOYAMA⁴, Hirotsugu HORIMI⁵, Yasuo TAMURA²

¹河野臨床医学研究所附属第三北品川病院臨床生理, ²河野臨床医学研究所附属第三北品川病院内科, ³医療法人財団謙仁会亀有病院内科, ⁴医療法人鉄蕉会亀田総合病院心臓血管外科, ⁵財団法人船員保険会せんぽ高輪病院心臓血管外科

¹Department of Clinical Laboratory, Third Kitashinagawa Hospital, ²Department of Internal Medicine, Third Kitashinagawa Hospital, ³Department of Internal Medicine, Kameari Hospital, ⁴Department of Cardiovascular Surgery, Kameda Medical Center, ⁵Department of Cardiovascular Surgery, Senpo-Takanawa Hospital

キーワード : bimanual cardiac massage, echocardiography, constrictive pericarditis

The low incidence of tuberculosis has made constrictive pericarditis (CP) a rare disease. CP has, however, been reported among patients who have undergone radiotherapy, heart surgery, and the like. One such case was that of a 36-year-old man who had been admitted on an emergency basis in 1991 and had undergone emergency surgery for hepatic trauma resulting from a traffic accident. Cardiac arrest occurred during surgery, but bimanual cardiac massage through the diaphragm was performed, and the patient recovered. Systemic edema and dyspnea on exertion developed and slowly and progressively worsened between 1993 and 1997. The patient was hospitalized again in 1997 for further evaluation. Echocardiography revealed overall thickening of the pericardium and paradoxical interventricular septal motion associated with CP. Doppler echocardiography showed a restrictive left ventricular inflow pattern, rapid deceleration of early filling, reduction in the E wave after inspiration, and respiratory change in the A wave. Cardiac catheterization showed elevated pressure in the right atrium and elevated end-diastolic pressure in the right ventricle, in addition to a pressure record of dip and plateau in the right ventricle, all of which are associated with CP. This case suggests the importance of long-term echocardiographic follow up of patients with histories of cardiopulmonary arrest who have been resuscitated by bimanual cardiac massage.