| Japanese |
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| Title | 術前低酸素血症を呈した巨大右房腫瘍摘出術の麻酔経験 |
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| Subtitle | 症例 |
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| Authors | 吉野淳, 森川敬子, 田中宏幸, 本山正岩, 瀬戸口秀一, 高橋成輔 |
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| Organization | 国立病院機構九州医療センター麻酔科・臨床研究部 |
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| Journal | 循環制御 |
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| Volume | 29 |
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| Number | 1 |
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| Page | 67-70 |
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| Year/Month | 2008/5 |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「はじめに」原発性の心臓腫瘍は稀な疾患である. 心臓腫瘍の中で最も多い粘液腫は左房に多く発生し, 右房に発生する粘液腫は約15%と稀である. 右房粘液腫では右心不全の進行や腫瘍の嵌頓による循環破綻に注意が必要である. さらに, 中心静脈カテーテル, 肺動脈カテーテル, また脱血カニューラ挿入時に腫瘍との干渉にも注意する必要がある. 今回, 術前に低酸素血症を合併した右房粘液腫に対して摘出術を施行した症例の麻酔管理を経験したので報告する. 「症例」症例：48歳, 女性. 主訴：労作時呼吸困難. 現病歴：1年前より自覚していた労作時の呼吸困難が増悪してきたために近医を受診した. 経胸壁心エコー上, 右房に巨大腫瘍を認めたため手術目的で緊急入院となった. 入院時現症：身長164cm, 体重54kg, 血圧112/74mmHg, 脈拍103/min・整, 呼吸数22/minと頻脈・頻呼吸を認めた. 聴診上, 左第3肋間に最強点を有するLevine IV/VIのto-and-fro murmurを聴取した. また, 頸静脈の怒張をみとめ, 腹部触診で上腹部正中に肝を三横指触知した. 平地歩行や軽度の労作で息切れ, 頻脈, SpO2の低下を認めていたため活動性をNYHA分類3度と評価した. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | right atrial myxoma, patent foramen ovale, right-to-left shunt, hypoxemia, transesophageal echocardiography |
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| English |
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| Title | Anesthetic Management of a Giant Right Atrial Myxoma with Severe Hypoxemia |
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| Authors | Jun Yoshino*, Keiko Morikawa*, Hiroyuki Tanaka*, Masaiwa Motoyama*, Hidekazu Setoguchi*, Shosuke Takahashi* |
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| Authors(kana) | |
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| Organization | *Department of Anesthesia and Clinical Research Institute, National Hospital Organization Kyushu Medical Center |
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| Journal | Circulation Control |
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| Volume | 29 |
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| Number | 1 |
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| Page | 67-70 |
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| Year/Month | 2008/5 |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | Primary right atrial myxoma is very rare. We report the anesthetic management of an emergent surgical resection of a right atrial myxoma in a 48-year-old female patient. Preoperative echocardiography revealed a right atrial mass of 80×34mm. Arterial blood gas showed marked hypoxemia with an oxygen tension (PaO2) of 52.5mmHg and oxygen saturation of 85.6%. Anesthesia was induced and maintained with propofol, remifentanil and vecuronium. We inserted a Swan-Ganz catheter from the internal jugular vein to monitor pulmonary arterial pressure. The tumor was removed under cardiopulmonary bypass and a patent foramen ovale (PFO), which had not been detected in preoperative transthoracic echocardiography, was found and closed. Arterial blood gas showed normal oxygenation with PaO2 of 569mmHg on FiO2 1.0 after weaning from cardiopulmonary bypass. The intraoperative hemodynamic conditions were stable without cardiopulmonary complications. Right atrial myxoma can produce functional stenosis of the tricuspid valve and cause an increase of right atrial pressure. Thus, right to left shunting can occur through PFO and result in central cyanosis in such patients. Attention must be given to hemodynamic stability and the possibility of tumor obstruction and dissemination in anesthetic management of right atrial myxoma. |
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| Practice | Basic medicine |
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| Keywords | right atrial myxoma, patent foramen ovale, right-to-left shunt, hypoxemia, transesophageal echocardiography |
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