A case of atrial septal aneurysm associated with atrial septal defect

症例は65歳男性で心疾患の既往なし.昭和63年5月より労作時疲労感が出現し通院中の泌尿器科で胸部X線に異常を指摘され当科受診.受診時軽度の心不全状態で,胸部X線上心拡大と肺動脈拡張を,心電図でIRBBB,左房負荷を認めた.心音図で4LSBで汎収縮期雑音を認めた.II音は軽度亢進を認めたが分裂はなかった.断層心エコー図では右室の拡大と卵円窩部に限局する心房中隔瘤を認めた.心房中隔に欠損孔は確認されず,Mモード上心室中隔の奇異性運動も認めなかった.右房造影で瘤は右房内陰影欠損として認められ,右心カテーテルでは肺高血圧(平均肺動脈圧36mmHg)があり,軽度の左右および右左シャントが示唆された。心エ...

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Published inShinzo Vol. 23; no. 7; pp. 757 - 762
Main Authors Itoh, Shigenori, Satoh, Yasumasa, Takeuchi, Toshihiko, Ogasawara, Tetsuya, Tanaka, Akitaka, Yazaki, Yutaka, Akita, Masashi, Takahashi, Yoshitsugu, Ozeki, Norishige, Takada, Yoshisuke, Itoh, Makoto, Kojima, Shoji
Format Journal Article
LanguageJapanese
Published Japan Heart Foundation 15.07.1991
Subjects
心エコー図
心房中隔欠損症
心房中隔瘤
心房問シャント
Online AccessGet full text
ISSN0586-4488
2186-3016
DOI10.11281/shinzo1969.23.7_757

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Abstract 症例は65歳男性で心疾患の既往なし.昭和63年5月より労作時疲労感が出現し通院中の泌尿器科で胸部X線に異常を指摘され当科受診.受診時軽度の心不全状態で,胸部X線上心拡大と肺動脈拡張を,心電図でIRBBB,左房負荷を認めた.心音図で4LSBで汎収縮期雑音を認めた.II音は軽度亢進を認めたが分裂はなかった.断層心エコー図では右室の拡大と卵円窩部に限局する心房中隔瘤を認めた.心房中隔に欠損孔は確認されず,Mモード上心室中隔の奇異性運動も認めなかった.右房造影で瘤は右房内陰影欠損として認められ,右心カテーテルでは肺高血圧(平均肺動脈圧36mmHg)があり,軽度の左右および右左シャントが示唆された。心エコー図上,瘤は通常は左房から右房に突出し,吸気初期には拡張末期,収縮早期に二相性に左房内に反転した.ジギタリス剤,利尿剤による治療約1年後には左房内への反転は減少し右房圧の低下が間接的に示唆された.同時期の2D-ドップラーで瘤の中央から右房に向かう血流が検出された.以上の所見より肺高血圧を伴う二次口型心房中隔欠損症に心房中隔瘤が合併したものと考えた.欠損孔は断層エコーで確認されず,一次中隔の吸収が異常位置で生じ卵円窩部心房中隔が網状となり脆弱性を帯びて瘤が形成されたものと推察した.本例は心房中隔欠損症を伴う心房中隔瘤の発生要因を考えるうえで非常に示唆に富む症例であり瘤の運動パターンの解析および若干の文献的考察を加えた.
AbstractList 症例は65歳男性で心疾患の既往なし.昭和63年5月より労作時疲労感が出現し通院中の泌尿器科で胸部X線に異常を指摘され当科受診.受診時軽度の心不全状態で,胸部X線上心拡大と肺動脈拡張を,心電図でIRBBB,左房負荷を認めた.心音図で4LSBで汎収縮期雑音を認めた.II音は軽度亢進を認めたが分裂はなかった.断層心エコー図では右室の拡大と卵円窩部に限局する心房中隔瘤を認めた.心房中隔に欠損孔は確認されず,Mモード上心室中隔の奇異性運動も認めなかった.右房造影で瘤は右房内陰影欠損として認められ,右心カテーテルでは肺高血圧(平均肺動脈圧36mmHg)があり,軽度の左右および右左シャントが示唆された。心エコー図上,瘤は通常は左房から右房に突出し,吸気初期には拡張末期,収縮早期に二相性に左房内に反転した.ジギタリス剤,利尿剤による治療約1年後には左房内への反転は減少し右房圧の低下が間接的に示唆された.同時期の2D-ドップラーで瘤の中央から右房に向かう血流が検出された.以上の所見より肺高血圧を伴う二次口型心房中隔欠損症に心房中隔瘤が合併したものと考えた.欠損孔は断層エコーで確認されず,一次中隔の吸収が異常位置で生じ卵円窩部心房中隔が網状となり脆弱性を帯びて瘤が形成されたものと推察した.本例は心房中隔欠損症を伴う心房中隔瘤の発生要因を考えるうえで非常に示唆に富む症例であり瘤の運動パターンの解析および若干の文献的考察を加えた.
Author Satoh, Yasumasa
Akita, Masashi
Itoh, Shigenori
Takahashi, Yoshitsugu
Yazaki, Yutaka
Ozeki, Norishige
Tanaka, Akitaka
Takeuchi, Toshihiko
Ogasawara, Tetsuya
Itoh, Makoto
Takada, Yoshisuke
Kojima, Shoji
Author_FL 伊藤 重範
Yazaki Yutaka
武内 俊彦
高田 善介
尾関 規重
Ogasawara Tetsuya
小島 照司
佐藤 泰正
高橋 佳嗣
秋田 真志
Tanaka Akitaka
伊藤 誠
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References 3) Lev M: Autopsy diagnosis of congenitally malformed hearts. Springfield, III, Charles C Thomas, 1953, pp 22-23
4) Casta A: Atrial septal aneurysm herniation across the mitral valve orifice in pulmonary atresia. Am Heart J 115: 1136-1138, 1988
6) Gallet B, Malergue MC, Adams C, et al: Atrial septal aneurysm-a potential cause of systemic embolism An echocardiographic study. Br Heart J 53: 292-297, 1985
9) Kondo T, Iwasaki T, Hiramatsu K, et al: Partial Resection of Atrial Septal Aneurysm with Multiple Fenestrations-A Case Report. Angiology 39: 838-842, 1988
8) Kong C-W and Chan W: The Echocardiographic Features of an Aneurysm of the Inter-Atrial Septum. Angiology 35: 188-194, 1984
5) Iliceto S, Papa A, Sorino M, et al: Combined Atrial Septal Aneurysm and Mitral Valve Prolapse: Detection by Two-Dimensional Echocardiography. Am J Cardiol 54: 1151-1153, 1984
2) Hanley PC, Tajik AJ, Hynes JK, et al: Diagnosis and Classification of Atrial Septal Aneurysm by Two-Dimensional Echocardiography: Report of 80 Consecutive Cases. JACC 6: 1370 -1382, 1985
7) Belkin RN, Hurwitz BJ and Kisslo J: Atrial Septal Aneurysm: Association with Cerebrovascular and Peripheral Embolic Events. Stroke 18: 856-862, 1987
1) Silver MD and Dorsey JS: Aneurysms of the Septum Primum in Adults. Arch Pathol Lab Med 102: 62-65, 1978
10)松岡優, 中沢誠: 心房中隔欠損. 臨床発達心臓病学. 高尾篤良編, 東京, 中外医学社, 1989, pp232-233
References_xml – reference: 4) Casta A: Atrial septal aneurysm herniation across the mitral valve orifice in pulmonary atresia. Am Heart J 115: 1136-1138, 1988
– reference: 7) Belkin RN, Hurwitz BJ and Kisslo J: Atrial Septal Aneurysm: Association with Cerebrovascular and Peripheral Embolic Events. Stroke 18: 856-862, 1987
– reference: 10)松岡優, 中沢誠: 心房中隔欠損. 臨床発達心臓病学. 高尾篤良編, 東京, 中外医学社, 1989, pp232-233
– reference: 8) Kong C-W and Chan W: The Echocardiographic Features of an Aneurysm of the Inter-Atrial Septum. Angiology 35: 188-194, 1984
– reference: 1) Silver MD and Dorsey JS: Aneurysms of the Septum Primum in Adults. Arch Pathol Lab Med 102: 62-65, 1978
– reference: 5) Iliceto S, Papa A, Sorino M, et al: Combined Atrial Septal Aneurysm and Mitral Valve Prolapse: Detection by Two-Dimensional Echocardiography. Am J Cardiol 54: 1151-1153, 1984
– reference: 9) Kondo T, Iwasaki T, Hiramatsu K, et al: Partial Resection of Atrial Septal Aneurysm with Multiple Fenestrations-A Case Report. Angiology 39: 838-842, 1988
– reference: 2) Hanley PC, Tajik AJ, Hynes JK, et al: Diagnosis and Classification of Atrial Septal Aneurysm by Two-Dimensional Echocardiography: Report of 80 Consecutive Cases. JACC 6: 1370 -1382, 1985
– reference: 3) Lev M: Autopsy diagnosis of congenitally malformed hearts. Springfield, III, Charles C Thomas, 1953, pp 22-23
– reference: 6) Gallet B, Malergue MC, Adams C, et al: Atrial septal aneurysm-a potential cause of systemic embolism An echocardiographic study. Br Heart J 53: 292-297, 1985
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SubjectTerms 心エコー図
心房中隔欠損症
心房中隔瘤
心房問シャント
Title A case of atrial septal aneurysm associated with atrial septal defect
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