乳頭筋断裂による急性僧帽弁閉鎖不全症,僧帽弁置換術後の重症心不全に対しトルバプタン投与が有効であった1例  [in Japanese] Efficacy of tolvaptan for postoperative congestive heart failure after cardiac surgery: a case of mitral valve replacement due to acute mitral regurgitation after coronary intervention  [in Japanese]

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Author(s)

    • 吉武 勇 Yoshitake Isamu
    • 日本大学医学部外科学系心臓血管・呼吸器・総合外科学分野 Department of Cardiovascular Surgery, Nihon University School of Medicine
    • 塩野 元美 Shiono Motomi
    • 日本大学医学部外科学系心臓血管・呼吸器・総合外科学分野 Department of Cardiovascular Surgery, Nihon University School of Medicine
    • 畑 博明 Hata Hiroaki
    • 日本大学医学部外科学系心臓血管・呼吸器・総合外科学分野 Department of Cardiovascular Surgery, Nihon University School of Medicine
    • 秦 光賢 Hata Mitsumasa
    • 日本大学医学部外科学系心臓血管・呼吸器・総合外科学分野 Department of Cardiovascular Surgery, Nihon University School of Medicine
    • 瀬在 明 Sezai Akira
    • 日本大学医学部外科学系心臓血管・呼吸器・総合外科学分野 Department of Cardiovascular Surgery, Nihon University School of Medicine
    • 飯田 充 Iida Mitsuru
    • 日本大学医学部外科学系心臓血管・呼吸器・総合外科学分野 Department of Cardiovascular Surgery, Nihon University School of Medicine
    • 大幸 俊司 Osaka Syunji
    • 日本大学医学部外科学系心臓血管・呼吸器・総合外科学分野 Department of Cardiovascular Surgery, Nihon University School of Medicine
    • 木村 玄 Kimura Haruka
    • 日本大学医学部外科学系心臓血管・呼吸器・総合外科学分野 Department of Cardiovascular Surgery, Nihon University School of Medicine
    • 八百板 寛子 Yaoita Hiroko
    • 日本大学医学部外科学系心臓血管・呼吸器・総合外科学分野 Department of Cardiovascular Surgery, Nihon University School of Medicine
    • 中田 金一 Nakata Kin-ichi
    • 日本大学医学部外科学系心臓血管・呼吸器・総合外科学分野 Department of Cardiovascular Surgery, Nihon University School of Medicine

Abstract

症例は64歳男性.呼吸苦を主訴にショックバイタルで救命センターへ搬送され,急性冠症候群の診断下に気管内挿管,強心剤投与,IABP挿入し緊急冠動脈造影検査を施行.RCA #1 100%に対し血栓吸引および冠動脈ステント挿入.治療中に乳頭筋断裂による急性僧帽弁閉鎖不全症を合併し,同日緊急僧帽弁置換術を施行.IABP,強心剤投与下に適宜利尿剤を用い加療継続するも,うっ血性心不全が遷延.術後3病日目よりトルバプタン7.5 mg胃管注入を併用したところ,血行動態および腎機能を悪化させることなく尿量の増加を認め,利尿剤投与量は減少し,うっ血性心不全は徐々に改善.術後8病日目に人工呼吸器を離脱し得た.その後トルバプタン投与は継続せず経過観察したが,リバウンドもなく心不全コントロールは良好であり,術後33病日目に退院した.心臓手術後の遷延した重症心不全に対するトルバプタン投与は安全かつ有効であり報告する.

A 64-year-old male was admitted to our hospital in the state of a cardiogenic shock with dyspnea. Electrocardiography and trans-thoracic echocardiogram showed an inferior myocardial infarction and coronary angiography revealed a total occlusion in segment 1 of right coronary artery. Percutaneous coronary intervention with bare-metal stents was performed under intra-aortic balloon pumping support, but acute mitral regurgitation was occurred during the procedure. Emergency mitral valve replacement and also optimal medical therapy (inotropic agent, diuretics, Carperitide, etc.) was performed immediately, but congestive heart failure was uncontrolled after operation. Tolvaptan was administered through the gastric tube at 3 days after operation, and the increase of urine volume was accepted without worsening a hemodynamics and a renal function, and congestion heart failure was improved gradually and could wean from the respirator in the 8 days after operation. Tolvaptan was administered for 5 days, the patient showed no worsening of heart failure even after stopping the administration of tolvaptan, and the patient was discharged in the 33 days after operation. Administered of Tolvaptan for the prolonged heart failure after a cardiac surgery was safe and effective.

Journal

  • Journal of the Japanese Coronary Association

    Journal of the Japanese Coronary Association 20(3), 209-213, 2014

    The Japanese Coronary Association

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