田村 淳史¹, 杉本 美夕¹, 嘉祥 敬国¹, 奥山 雄介¹, 松岡 俊三¹, 青木 昭和²

Atsushi TAMURA¹, Miyu SUGIMOTO¹, Keikoku KASHO¹, Yusuke OKUYAMA¹, Shunzo MATSUOKA¹, Showa AOKI²

¹医療法人徳洲会宇治徳洲会病院心臓血管内科, ²医療法人徳洲会宇治徳洲会病院産婦人科

¹Department of Cardiovascular Medicine,Uji-Tokushukai Medical Center, ²Department of Obstetrics and Gynecology, Uji-Tokushukai Medical Center

キーワード : cor triatriatum, atrial fibrillation, catheter ablation

先天性三心房心（cor triatriatum：CT）は，先天性心疾患の0.1～0.4％を占める稀な疾患である．心房の異常隔壁により心房が二分され様々な症状を呈する．心房細動（atrial fibrillation：AF）は約30％の患者に合併するとされる．今回我々は，AFに対するカテーテルアブレーションの術前検査として施行した経食道心エコー図検査（trans-esophageal echocardiography：TEE）で，先天性左房性三心房心（CT sinister：CTS）を認めた症例を経験した．CTSには，部分肺静脈灌流異常や心房中隔欠損を合併することがある．また，異常隔壁がカテーテルの通過障害の原因となりうるため，術前精査を詳細に行った．先天性心疾患の合併は認めず，隔壁は心房中隔のやや僧帽弁側に付着し，全ての肺静脈が副腔に還流していたことから拡大肺静脈隔離術（extensive encircling pulmonary vein isolation：EEPVI）を実施可能と判断した．心房中隔穿刺時に心腔内エコーを用いて副腔側を選択的に穿刺し，EEPVIを安全に施行できた．AFを合併したCTS患者に対し，術前にTEEを中心とした様々なモダリティを用いて左房形態や合併奇形を精査し，安全な治療を計画することは重要である．

Cor triatriatum (CT) is a rare congenital heart disease (CHD) that accounts for about 0.1-0.4% of CHD cases. It causes various clinical symptoms due to an abnormal septum in the right or left atrium. Atrial fibrillation occurs in about 30% of all CT patients. We describe a case of an adult male who presented with symptomatic CT sinister. He had paroxysmal atrial fibrillation, and he was incidentally diagnosed with CT sinister based on transesophageal echocardiography performed for preoperative workup for catheter ablation. In patients with CT, other CHDs such as partial anomalous pulmonary venous connection or atrial septal defect often coexist. In addition, the abnormal septum may cause obstruction of catheter passage. We carefully considered whether extensive encircling pulmonary vein isolation (EEPVI) could be safely performed. He had no other CHDs, and his abnormal septum was located in the lower atrial septum. Thus, we performed EEPVI without complication using intracardiac echocardiography for transseptal puncture. It is important to consider whether catheter ablation can be safely performed using various modalities. We described a case of CT with paroxysmal atrial fibrillation.