冠状動脈造影で正常像を呈した心筋梗塞後左心室瘤の1例

A case of left ventricular aneurysm with normal coronary arteries after acute myocardial infarction

　心筋梗塞は冠状動脈の動脈硬化性病変を基盤として発生するのが大部分である。ましてや心筋梗塞後左心室瘤は大部分が冠状動脈のより高度な狭窄や閉塞から発生するといわれている。しかし，症状のうえから，心電図のうえから，さらには血清酵素の動きのうえからも明らかに心筋梗塞を経過したと考えられるにもかかわらず，冠状動脈造影上は正常像を呈する症例の報告が最近よく見られるようになった。ただ，冠状動脈造影上正常像を呈する心筋梗塞後左心室瘤の症例の報告は非常に少ない。

　最近，われわれは明らかな心筋梗塞を経過したのちに，それが原因と考えられる左心室瘤を合併したにもかかわらず，正常冠状動脈造影所見を呈し，その後の左心室瘤切除術にて良好な結果を得た1例を経験したので報告する。

A 47-year old man was admitted to our hospitalon May 20, 1982 complaining of anterior chestchoke feeling, dyspnea and palpitation. He had suffered from these complaints since two days before.

Physical examinations on admission, serial electrocardiograms and enzyme studies confirmed the diagnosis of congestive heart failure due to acute transmural myocardial infarction. He had a favorite course being treated with anticoagulants, digitalis, diuretics, antiarrhythmics and vasodila-tors.

Cardiac catheterization was performed. The cardiac index was 3.7 liters/min/m2 and the left end-diastolic pressure was 14 mmHg. The ven-tricular angiogram demonstrated the aneurysmal movement of segment 2 and 3 and the ejection fraction was 56%. Selective coronary arteriography showed normal coronary arteries.

Since he had frequent ventricular premature beats at exercise by the bicycle ergometry, he underwent an operation. The aneurysm was local-ized at the left ventricular apex and resected successfully with mural thrombi. The thickness of the wall was about 10 mm. The post-operative clinical course was uneventful.

In the recent years, scattered reports have appeared, describing cases of myocardial infarction with normal coronary arteriogram but those of of left ventricular aneurysm with normal coronary arteriogram after myocardial infarction are very rarely reported. Our present case is added to the latter.