症例 僧帽弁輪下左室瘤を合併した僧帽弁閉鎖不全症の1例
感染性心内膜炎の経過中に,巨大な仮性左室瘤を合併した僧帽弁閉鎖不全症例を経験した.僧帽弁後尖側弁輪直下に横径約2cmの瘤との交通部を認め,同部より生じた仮性左室瘤が左房とも交通したものと考えられた.左房左室内腔より僧帽弁人工弁置換術および瘤入口部閉鎖を行い,著明な心機能の改善を得た.手術時には既に心内膜炎の所見は見られず,仮性左室瘤発生の要因として僧帽弁輪石灰化による影響も考えられた.感染性心内膜炎に起因する仮性左室瘤はまれであり,僧帽弁輪下より生じた報告例はごく少数である.早期の診断と手術治療が必要と考える....
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| Published in | 心臓 Vol. 25; no. 8; pp. 975 - 980 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益財団法人 日本心臓財団
1993
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo1969.25.8_975 |
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| Abstract | 感染性心内膜炎の経過中に,巨大な仮性左室瘤を合併した僧帽弁閉鎖不全症例を経験した.僧帽弁後尖側弁輪直下に横径約2cmの瘤との交通部を認め,同部より生じた仮性左室瘤が左房とも交通したものと考えられた.左房左室内腔より僧帽弁人工弁置換術および瘤入口部閉鎖を行い,著明な心機能の改善を得た.手術時には既に心内膜炎の所見は見られず,仮性左室瘤発生の要因として僧帽弁輪石灰化による影響も考えられた.感染性心内膜炎に起因する仮性左室瘤はまれであり,僧帽弁輪下より生じた報告例はごく少数である.早期の診断と手術治療が必要と考える. |
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| AbstractList | 感染性心内膜炎の経過中に,巨大な仮性左室瘤を合併した僧帽弁閉鎖不全症例を経験した.僧帽弁後尖側弁輪直下に横径約2cmの瘤との交通部を認め,同部より生じた仮性左室瘤が左房とも交通したものと考えられた.左房左室内腔より僧帽弁人工弁置換術および瘤入口部閉鎖を行い,著明な心機能の改善を得た.手術時には既に心内膜炎の所見は見られず,仮性左室瘤発生の要因として僧帽弁輪石灰化による影響も考えられた.感染性心内膜炎に起因する仮性左室瘤はまれであり,僧帽弁輪下より生じた報告例はごく少数である.早期の診断と手術治療が必要と考える. |
| Author | 木口, 英子 古川, 欽一 内野, 敬 石井, 俊彦 石井, 壽晴 長田, 鉄也 橋本, 雅史 内山, 隆史 工藤, 龍彦 伊吹山, 千晴 増田, 茂 |
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| References | 11) Buehler DL, Stinson EB, Oyer PE, et al: Surgical treatment of aneurysms of the inferior left ventricular wall. J Thorac Cardiovasc Surg 78: 74-78, 1979 15) Burnside JW, Desanctis RW: Bacterial endocarditis on calcification of the mitral anulus fibrosus. Ann Inter Med 76: 615-618, 1972 3) Bansal RC, Graham BM, Jutzy KR, et al: Left ventricular outflow tract to left atrial communication secondary to rupture of mitral- aortic intervalvular fibrosa infective e ndocarditis: Diagnosis by transesophageal echocardiography and color flow imaging. J Am Coll Cardiol 15: 499-504, 1990 1) Bansal RC, Moloney PM, Marsa RJ, et al: Echocardiographic features of a mycotic aneurysm of the left ventricular outflow tract caused by perforation of mitral-aortic intervalvular fibrosa. Circulation 67: 930-934, 1983 13) Winek RR, Schwenk NM and Edwards WD: Fatal hemopericardium due to ruptured solitary myocardial abscess unassociated with infective endocarditis. Am J Cardiovasc Pathol 1: 255-257, 1988 2) Qizilbash AH, Schwartz CJ: False aneurysm of the left ventricle due to perforation of mitralaortic intervalvular fibrosa with rupture and cardiac tamponade. Am J Cardiol 32: 110-113, 1973 5) Spellberg RD, O'Reilly RJ: Pseudoaneurysm of the left ventricle following mitral valve replacement. Chest 62: 115-117, 1972 8) Wolpowitz A, Arman B, Barnard MS, et al: Annular subvalvular idiopathic elft ventricular aneurysms in the black african. Ann Thorac Surg 27: 350-355, 1979 4)山下長司郎, 中村宏臣, 矢野隆, ほか: 僧帽弁閉鎖不全を呈した僧帽弁輪下左室瘤の1治験例. 日胸外会誌39: 1208-1211, 1991 14) Fulkerson PK, Beaver BM, Auseon JC, et al: Calcification of the mitral annulus: etiology, clinical associations, complications and therapy. Am J Med 66: 967-977, 1979 10) Saksena FB, Kramer NE, Towne WD, et al: Infective aneurysm of the left ventricle: Angiographic and echocardiographic features. Am Heart 196: 384-388, 1978 6) Verkkala K, Maamies T, Kupari M, et al: Pseudoaneurysm of the left ventricle following mitral valve replacement. J Cardiovasc Surg 31: 242-246, 1990 16) Sutorius DJ, Helmsworth JA, Majeski JA, et al: Repair of a subvalvular left ventricular aneurysm following mitral valve replacement. Ann Thrac Surg 32: 92-96, 1981 12) Kessler KM, Kieval J, Saksena S, et al: Echographic features of posterior left ventricular wall pseudoaneurysm due to Escherichia coli endocarditis. Am Heart J 103: 139-142, 1982 9)高木宏治, 石丸敏之, 金谷庄蔵, ほか: 心筋破裂による心タンポナーデを合併した感染性心内膜炎の1剖検例. 感染症学雑誌64: 1550-1555, 1990 7) Waldhausen JA, Petry EL and Kurlander GJ: successful repair of subvalvular annular aneurysm of the left ventricle. N Engl J Med 275: 984-987, 1966 |
| References_xml | – reference: 10) Saksena FB, Kramer NE, Towne WD, et al: Infective aneurysm of the left ventricle: Angiographic and echocardiographic features. Am Heart 196: 384-388, 1978 – reference: 6) Verkkala K, Maamies T, Kupari M, et al: Pseudoaneurysm of the left ventricle following mitral valve replacement. J Cardiovasc Surg 31: 242-246, 1990 – reference: 8) Wolpowitz A, Arman B, Barnard MS, et al: Annular subvalvular idiopathic elft ventricular aneurysms in the black african. Ann Thorac Surg 27: 350-355, 1979 – reference: 9)高木宏治, 石丸敏之, 金谷庄蔵, ほか: 心筋破裂による心タンポナーデを合併した感染性心内膜炎の1剖検例. 感染症学雑誌64: 1550-1555, 1990 – reference: 16) Sutorius DJ, Helmsworth JA, Majeski JA, et al: Repair of a subvalvular left ventricular aneurysm following mitral valve replacement. Ann Thrac Surg 32: 92-96, 1981 – reference: 1) Bansal RC, Moloney PM, Marsa RJ, et al: Echocardiographic features of a mycotic aneurysm of the left ventricular outflow tract caused by perforation of mitral-aortic intervalvular fibrosa. Circulation 67: 930-934, 1983 – reference: 4)山下長司郎, 中村宏臣, 矢野隆, ほか: 僧帽弁閉鎖不全を呈した僧帽弁輪下左室瘤の1治験例. 日胸外会誌39: 1208-1211, 1991 – reference: 7) Waldhausen JA, Petry EL and Kurlander GJ: successful repair of subvalvular annular aneurysm of the left ventricle. N Engl J Med 275: 984-987, 1966 – reference: 5) Spellberg RD, O'Reilly RJ: Pseudoaneurysm of the left ventricle following mitral valve replacement. Chest 62: 115-117, 1972 – reference: 12) Kessler KM, Kieval J, Saksena S, et al: Echographic features of posterior left ventricular wall pseudoaneurysm due to Escherichia coli endocarditis. Am Heart J 103: 139-142, 1982 – reference: 2) Qizilbash AH, Schwartz CJ: False aneurysm of the left ventricle due to perforation of mitralaortic intervalvular fibrosa with rupture and cardiac tamponade. Am J Cardiol 32: 110-113, 1973 – reference: 13) Winek RR, Schwenk NM and Edwards WD: Fatal hemopericardium due to ruptured solitary myocardial abscess unassociated with infective endocarditis. Am J Cardiovasc Pathol 1: 255-257, 1988 – reference: 11) Buehler DL, Stinson EB, Oyer PE, et al: Surgical treatment of aneurysms of the inferior left ventricular wall. J Thorac Cardiovasc Surg 78: 74-78, 1979 – reference: 3) Bansal RC, Graham BM, Jutzy KR, et al: Left ventricular outflow tract to left atrial communication secondary to rupture of mitral- aortic intervalvular fibrosa infective e ndocarditis: Diagnosis by transesophageal echocardiography and color flow imaging. J Am Coll Cardiol 15: 499-504, 1990 – reference: 14) Fulkerson PK, Beaver BM, Auseon JC, et al: Calcification of the mitral annulus: etiology, clinical associations, complications and therapy. Am J Med 66: 967-977, 1979 – reference: 15) Burnside JW, Desanctis RW: Bacterial endocarditis on calcification of the mitral anulus fibrosus. Ann Inter Med 76: 615-618, 1972 |
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| Title | 症例 僧帽弁輪下左室瘤を合併した僧帽弁閉鎖不全症の1例 |
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