Koga Yuichi, Miyamoto Utako, Ushikusa Jun, Kawasaki Hiromitsu, Takeda Yuji, Sato Manabu
Department of Cardiovascular Surgery, Saga-ken Medical Centre Koseikan, Saga, Japan.
Kyobu Geka. 2024 Oct;77(11):966-970.
When respiratory failure occurs due to intractable pleural effusion, frequent thoracentesis is necessary. We herein report a patient who underwent diaphragmoplasty and pleuroperitoneal shunt for refractory pleural effusion after cardiac surgery. The patient was an 82-year-old man with a history of tricuspid valve replacement for tricuspid regurgitation 9-years ago. Heart failure recurred due to prosthetic valve dysfunction, and he underwent repeat tricuspid valve replacement. Postoperatively, he had right diaphragmatic nerve palsy and required frequent thoracentesis for persistent dyspnea on exertion and pleural effusion. He underwent thoracoscopically-assisted right diaphragmatic plication and right pleuro-peritoneal shunting using a Denver shunt. Dyspnea subsided, and pleural effusion disappeared. Diaphragmatic plication and pleuro-peritoneal shunting using a Denver shunt for refractory pleural effusion with diaphragm elevation may improve patient's quality of life.
当因顽固性胸腔积液导致呼吸衰竭时，频繁胸腔穿刺是必要的。我们在此报告一例心脏手术后因难治性胸腔积液接受膈肌折叠术和胸膜腹膜分流术的患者。该患者为82岁男性，9年前因三尖瓣反流接受三尖瓣置换术。因人工瓣膜功能障碍心力衰竭复发，他再次接受三尖瓣置换术。术后，他出现右侧膈神经麻痹，因运动时持续呼吸困难和胸腔积液需要频繁胸腔穿刺。他接受了胸腔镜辅助下的右侧膈肌折叠术和使用丹佛分流管的右侧胸膜腹膜分流术。呼吸困难缓解，胸腔积液消失。对于伴有膈肌抬高的难治性胸腔积液，使用丹佛分流管进行膈肌折叠术和胸膜腹膜分流术可能会改善患者的生活质量。
