| Japanese |
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| Title | 解離性大動脈瘤手術後に心臓交感神経の除神経が出現した1症例 - 123I-MIBGシンチグラフィを用いた評価 - |
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| Subtitle | 症例報告 |
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| Authors | 池上晴彦*, 小林秀樹*, 百瀬満*, 牧正子*, 日下部きよ子*, 青見茂之**, 小柳仁**, 冨久尾美帆***, 迫村泰成***, 笠貫宏*** |
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| Authors(kana) | |
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| Organization | *東京女子医科大学放射線科, **東京女子医科大学循環器外科, ***東京女子医科大学循環器内科 |
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| Journal | 核医学 |
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| Volume | 35 |
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| Number | 1 |
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| Page | 21-27 |
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| Year/Month | 1998/1 |
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| Article | 報告 |
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| Publisher | 日本核医学会 |
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| Abstract | 「要旨」解離性大動脈瘤に対して施行された人工血管置換術後に, 123I-MIBGシンチグラフィ(MIBG)上で心臓交感神経の除神経が確認された1例を経験した. 症例は60歳の男性で, 解離性大動脈瘤の診断で緊急入院となった. CT上で解離は上行から弓部大動脈におよぶ Debakey II型であり, 心嚢液貯留を認めたため, 解離部位に対して人工血管置換術が施行された. 術前のMIBGでは心臓は明瞭に描出されていたが, 術後に施行されたMIBGでは心集積は著明に低下しており, 手術後に心臓交感神経の除神経が生じたと考えられた. 24時間心電図の心拍変動解析から求めた低周波領域, 高周波領域の各パワーおよび両者の比LF/HFも著明に減弱しており, MIBG所見と同様に除神経の所見を認めた. 心移植後に心臓の除神経が生じることは明らかにされているが, 本症例は上行から弓部大動脈の人工血管置換術後に除神経が生じていることが確認された貴重な症例であると考え報告した. |
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| Practice | 臨床医学：一般 |
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| Keywords | 123I-MIBG, Dissecting aneurysm, Denervation, Cardiac sympathetic nerve, Aortic surgery |
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| English |
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| Title | Cardiac Sympathetic Denervation after Aortic Surgery in a Patient with Thoracic Dissecting Aneurysm : A Case Report |
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| Subtitle | Case Report |
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| Authors | Haruhiko IKEGAMI*, Hideki KOBAYASHI*, Mitsuru MOMOSE*, Masako MAKI*, Kiyoko KUSAKABE*, Shigeyuki AOMI**, Hitoshi KOYANAGI**, Miho FUKUO***, Yasunari SAKOMURA***, Hiroshi KASANUKI*** |
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| Authors(kana) | |
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| Organization | *Department of Radiology, Tokyo Women's Medical College, **Department of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical College, ***Department of Cardiac Surgery, The Heart Institute of Japan, Tokyo Women's Medical College |
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| Journal | The Japanese Journal of nuclear medicine |
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| Volume | 35 |
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| Number | 1 |
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| Page | 21-27 |
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| Year/Month | 1998/1 |
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| Article | Report |
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| Publisher | THE JAPANESE SOCIETY OF NUCLEAR MEDICINE |
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| Abstract | We experienced a case of 60 year-old man with cardiac sympathetic denervation after aortic graft replacement of ascending aorta for a dissecting aneurysm (Debakey type II). Fourteen years after pheochromocytomectomy (paraganglioma), the patient developed a severe chest pain, and admitted to the hospital for the diagnosis of dissecting aneurysm. CT scan with contrast enhancement revealed thrombosed dissecting aneurysm in the region of ascending aorta to aortic arch. Graft replacement was undergone on the same day. 123I-MIBG imaging 20 days after the operation showed severely attenuated myocardial uptake (heart to mediastinum ratio 1.19), although the MIBG imaging before the operation showed normal myocardial uptake (heart to mediastinum ratio 1.55). Heart rate variability analysis in Holter ECG showed that the power of the low frequency (LF), that of the high frequency (HF) and L/H ratio were severely decreased. MIBG and heart rate variability analysis indicated that cardiac sympathetic and parasympathetic nerve were denervated. This is the first report of cardiac sympathetic denervation after aortic vascular surgery. Clinical significance of cardiac sympathetic denervation after aortic vascular surgery is uncertain, and further investigation will be required. |
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| Practice | Clinical medicine |
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| Keywords | 123I-MIBG, Dissecting aneurysm, Denervation, Cardiac sympathetic nerve, Aortic surgery |
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