胸部鈍的外傷後のリハビリテーション中に出現した急性心不全

―外傷性大動脈弁閉鎖不全症の1例―

抄録

The patient was a 70-year-old man. He was injured in a motorcycle accident and was brought to the hospital suffering from pulmonary contusions, multiple rib fractures, and a dislocation fracture of the left hip joint. Mechanical ventilation and tracheostomy were performed because of decreased oxygenation. As dysphagia and gait disturbance persisted even after his respiratory condition improved, the patient was transferred to our institution for rehabilitation 63 days after the injury. Rehabilitative intervention for the patient's physical impairments progressed smoothly, and the patient regained independence in activities of daily living. However, 1 week before his scheduled date of discharge, the patient suffered from sudden heart failure at 168 days after the initial injury. Traumatic aortic regurgitation was diagnosed based on the following findings : aortic regurgitation rapidly exacerbated after heart failure, no medical history of heart disease, and no other cause for aortic regurgitation. Surgical treatment with aortic valve replacement was performed. Postoperative recovery was favorable, and the patient was discharged to his home after regaining independence in activities of daily living. Traumatic aortic regurgitation is rare, and patients with this disease often suffer heart failure from a few days to several years after injury. This condition needs to be kept in mind during the rehabilitation process following chest trauma.