日本語AIでPubMedを検索
僧帽弁狭窄症を合併した心臓水腫嚢胞の1例
Hydatid cyst of the heart with mitral valve stenosis; Case report.
PMID: 31890197 PMCID: PMC6926137. DOI: 10.1016/j.amsu.2019.11.018.
抄録
心臓の水疱性嚢胞は非常に稀であり、左冠血管が支配的で壁が厚いため、左心室が最も一般的な心筋病変部位である。孤立性の心臓病変は極めて稀である。患者は無症状の場合もあるが、嚢胞が原因で動悸、呼吸困難、胸痛、心腔や心膜腔内で破裂した場合にはアナフィラキシー反応、心タンポナーデによる突然の虚脱、あるいは突然死などの緊急症状を起こすことがある。中年女性が2年前から労作性の息切れを呈した。心エコー検査では僧帽弁狭窄を認めた．胸部CT検査では右心室壁から発生した大きな複雑な胞子嚢胞を認めた．嚢胞を切除して胸骨中央部を切開し，僧帽弁狭窄をcommissurotomyで修復した．アルベンダゾールを3サイクル3ヶ月間投与した。心嚢胞が心膜に影響を与えている場合は完全切除が可能であるが、心筋に影響を与えている場合は完全切除は困難であり、不可能な場合もある。ケアは、導電システム、乳頭筋、大動脈と僧帽弁への損傷を避けるために取られなければなりません。術後は再発率を下げるために駆虫薬による内科的治療を行います。
Hydatid cyst of the heart is very rare, the left ventricle is the commonest site of myocardial involvement due to dominant left coronary vessels and thicker wall. Isolated cardiac involvement is extremely rare. Patients may be quite asymptomatic but the cyst may cause palpitation, dyspnea, chest pain, or when ruptured in to the cardiac or pericardial cavities may cause emergency presentations like anaphylactic reactions, sudden collapse due to pericardial tamponade or even sudden death. A middle age female presented with exertional shortness of breath for 2 years. Echocardiography showed mitral valve stenosis. Computerized tomography scan of the chest showed a big complicated hydatid cyst arising from the wall of the right ventricle. Median sternotomy was done with excision of the hydatid cyst, and repair of mitral stenosis by commissurotomy. The patient received three cycles of albendazole for three months. Surgery is the best options of treatment of cardiac hydatid disease, when the disease is affecting the pericardium complete excision may be possible, but when the myocardium is involved it may be difficult or even impossible to do complete excision, in this situation the cyst contents should be evacuated completely, preventing spillage is very mandatary to prevent recurrence. Care must be taken to avoid damage to the conductive system, the papillary muscles, the aortic and the mitral valves. Medical treatment with anthelminthic medications is used after surgery to reduce the recurrence rate.
© 2019 The Author(s).