伊藤 寿朗, 塚本 勝, 井上 聡巳, 村木 里誌, 安倍 十三夫

Toshiro ITO, Masaru TSUKAMOTO, Satomi INOUE, Satoshi MURAKI, Tomio ABE

札幌医科大学医学部第2外科学講座

Second Department of Surgery, Sapporo Medical University School of Medicine

キーワード : Ligation of the left atrial appendage, Transesophageal echocardiography, Local myocardial thickening, Phased tracking, Ultrasonic transcutaneous measurement

A 50-year-old woman with a history of atrial fibrillation underwent mitral valve replacement (MVR) and ligation of the left atrial appendage (LAA) because of mitral regurgitation in 1986. Sinus rhythm replaced atrial fibrillation soon after the operation. In 1996 screening Doppler echocardiography showed an abnormal flow suspected of being the paravalvular leakage (PVL) of MVR in the left atrium. Transesophageal echocardiography conducted to evaluate the abnormal flow in detail clearly showed the origin of the abnormal flow to be the ligated neck of the LAA, not a paravalvular site. The high velocity to-and-fro Doppler signal suggested ejection flow into the left atrium from the ligated but communicating LAA. We considered that the communicating flow between the LAA and left atrium increased after recovery of sinus rhythm and appeared as an abnormal high-velocity flow in the left atrium. Transesophageal echocardiography proved most useful for detailed evaluation of abnormal flow in the left atrium.