右室優位の拡張型心筋症の1剖検例

An autopsy case of dilated cardiomyopathy with predominantly illed right ventricle

　拡張型心筋症は主に左室心筋が冒され，左心不全を呈する。右室心筋が冒され，右心不全が前景に出ることは稀である。また，心筋症に種々の不整脈が合併し，心不全と共に予後を左右する。今回，著者らは著明な右室拡大，三尖弁閉鎖不全，右心不全を呈し，15年間に及ぶ心電図記録を有する1剖検例を経験したので報告する。

An autopsy case of a 63-year-old female with dilated cardiomyopathy with right heart failure, tricuspid regurgitation and a 15-year follow up of ECG was presented.

The patient admitted to our hospital because of dyspnea on mild exertion and ankle edema in March, 1985. ECG in 1971 at her age of 46 years revealed the first degree AV block. Within a few years since then, the disturbance of AV conduction pro-gressed complete AV block with ventricular escape rate of 42/min. P-wave showed atrial flutter during 1973 to 1976, and was not recorded on ECG in 1982. Chest X-ray on admission showed marked cardiac enlargement with cardiothoracic ratio of 0.80. M-mode, 2-dimensional and collor doppler echocardiograms showed dilated ventricular cham-bers and severe tricuspid regurgitation. Heart catheterization revealed diminished contractility of chambers with LVEF of 0.37 and RVEF of 0.31. A diagnosis of idiopathic dilated cardiomyopathy with predominantly illed right ventricle was ensured by biopsy of the right ventricle. After admission, the patient was implanted a permanent pacemaker. The symptomes improved temporally, but 4 months later since the implantation, she died from congestive heart failure. Autopsy was performed. In addition to the both ventricular diffuse, myocardial fibrosis, the histological findings of the sinus node and the tract to the AV node were fibrosis, haemorrhage and focal lymphocyte infiltration and that of the AV node showed fibrosis.