大動脈弁閉鎖不全症と僧帽弁閉鎖不全症を合併した強直性脊椎炎の1症例

A case of ankylosing spondylitis associated with aortic insufficiency and mitral regurgitation

　強直性脊椎炎に合併する心病変として，成書には大動脈弁閉鎖不全症が記載されており，特異な合併症として知られている^1）が，本邦では実地臨床上，本疾患に遭遇することはまれである。今回我々は，強直性脊椎炎の患者でHLA-B 27陽性でI度の房室ブロック，大動脈弁閉鎖不全症，僧帽弁閉鎖不全症を合併した症例を経験したので報告する。

A 47 year old man was referred to Tokyo Medical and Dental University Hospital with complaints of stiffness both in the lower and neck portions of his spine and exertional dyspnea. His heart murmur was pointed out in a certain clinic 3 years before this admission. Physical examination on admission revealed a short stooped man. The heart murmur was harsh pansystolic at apex which transmitted to left axilla. Aortic regurgitant murmur was not heard. Leg edema was not detected. Erythrocyte sedimentation rate (ESR) was 24 mm (1 hr), CRP was 3+. Ultra-sound cardiography showed the dilatations of left atrium and left ventricle and fine fluttering of anterior mitral leaflet, but no findings on organic changes of cardiac valves. Cardiac catheterization shows 135 ml of LVEDV and 4.1 l/min. of CO, 8 mmHg of LVEDP.

This case is 5th one among ankylosing spondy-litis patients with cardiac lesions in Japan. In this case, the degree of mitral regurgitation was greater than aortic regurgitation which is interesting in view of the pathogenesis of this lesion. The mitral valve lesion could be caused by the same etiology as of ankylosing spondylitis considering from the data of cardiac catheterization, LV-graphy and UCG exa-minations.