左バルサルバ洞より発する右冠動脈起始異常の1例

A case of anomalous right coronary origin from the left sinus of valsalva

　近年，選択的冠動脈造影法が進歩し，種々の先天的冠動脈起始異常が，臨床的に診断できるようになった。冠動脈起始異常は左冠動脈が右バルサルバ洞から出るものと，右冠動脈が左バルサルバ洞から出るものとの二種類に大別される。病因論的には前者の場合，運動中の不慮の突然死が多いとされているが，後者については報告例も少なく，その病因論的意義はまだ明確にされていない。今回，著者らは心室性期外収縮が発作的に出現する患者に，選択的冠動脈造影と大動脈造影を施行したところ，偶々右冠動脈が左バルサルバ洞から起始していることを見い出した。本例は稀有な冠動脈起始異常と思われるので，病因論的にも若干の考察を加え，報告する。

A 30-year old man with a 6-year history of hypertension was admitted because of chest oppression. He was extremely obese; +59.7% overweight. On admission his blood pressure was 180/110 mmHg and the pulse 72, regular. The cardiac dullness was slightly enlarged to the left, but no heart murmur was audible. No edema was noted. A glucose tolerance test showed mild diabetic pattern. Routine blood chemistry showed increases in triglyceride, uric acid and NEFA levels, 298 mg/100 ml, 8.9 mg/100 ml, 0.92 mEq/1, respectively. Although the chest X-ray film ex-hibited mild cardiomegaly and UCG showed mild concentric left ventricular hypertrophy, ECG disclosed neither hypertrophy nor ischemic change. The exercise tolerance test was negative.

Soon after admission his high blood pressure fell to the normal level. The exercise therapy combined with caloric restriction for marked obesity, resulted in a considerable weight reduc-tion with a normalization of the serum trigly-ceride, uric acid and NEFA 3 months after initiation of the therapy. The cardiac silhouette also became smaller than that on admission. Despite of these improvements in blood chemis-try, chest oppression which was precipitated just after exercise and continued for 3 hours developed several times. The ECG monitor during the attacks disclosed ventricular premature beats.