大沼 芳子¹, 水島 浩行¹, 石瀬 久也², 神保 正樹²

Yoshiko ONUMA¹, Hiroyuki MIZUSHIMA¹, Hisanari ISHISE², Masaki JINBO²

¹姫川病院中央検査部, ²姫川病院内科

¹Department of Central Clinical Laboratory, Himekawa Hospital, ²Department of Internal Medicine, Himekawa Hospital

キーワード : percutaneous transvenous mitral commissurotomy, echocardiography, Lutembacher’s syndrome, atrial septal aneurysm, stretched foramen ovale

重症僧帽弁狭窄症のために著明な左房と卵円孔の拡大で心房中隔瘤と心房間左‐右シャントとが生じ，Lutembacher症候群と同様な血行動態になった78歳の女性を報告した．経皮的経静脈的僧帽弁交連切開術が施行されたが，心拍出量の増加は芳しくなく，慢性右心不全の所見を徐々に呈した．左‐右シャントが生じた前後の超音波検査の経過を追うことが出来た稀な症例と考えられた．

We report our experience with a 78-year-old woman who presented with hemodynamics like those of Lutembacher’s syndrome. The patient had an atrial septal aneurysm and an interatrial right-to-left shunt caused by marked enlargement of the left atrium and the foramen ovale resulting from serious mitral stenosis. Although percutaneous transvenous mitral commissurotomy was carried out, subsequent increase in cardiac output was insufficient and chronic heart failure became evident. This suggests the appropriateness of early surgery when the right-to-left shunt appears in cases like this one.