膵頭部癌術後にmyocardial stunningを呈した1例

Abstract

We report a 60-year-old male with pancreatic head cancer presenting myocardial stunning just after the modified Child operation. He had neither a history of angina pectoris, nor electrocadiographic abnormalities before surgery. On 20 hours after surgery, 12-lead electrocardiogram showed a typical pattern suggesting the existence of acute wide anterior myocardial infarction, that is, ST-elevation in leads Ⅰ, ₐⅤʟ, and Ⅴ₁～Ⅴ₆, although the patient had no chest pain. Emergent cardiac catheterization was performed, and revealed akinesis in the anterior wall on left ventriculogram, while there was no organic stenosis on coronary arteriogram. Peak value of creatinine kinase during his admission was just over the upper limit of normal. Left ventriculogram on the 34th hospital day showed perfectly intact wall motion. Reversible myocardial infaction after abdominal surgery was first reported in 1976 by Kuramoto ; however, the pathophysiology of this phenomenon still remains debatable. This is the first case report presenting myocardial stunning just after pancreatic surgery.