心室頻拍，発作性房室ブロックおよび心室瘤を伴った右冠動脈左バルサルバ洞起始症の1例

A case of anomalous origine of right coronary artery from the left sinus of Valsalva with ventricular aneurysm ventricular tachycardia and paroxysmal A-V block

　右冠動脈の左バルサルバ洞起始症は比較的稀な冠動脈奇形であるが，本症には不整脈および心筋梗寒の合併や突然死が報告されており^1〜3），臨床的に興味がもたれる疾患である。

　今回，著者らは失神発作の原因として心室頻拍および発作性房室ブロックを認め，かつ左室の著明な拡大と心室瘤を伴った右冠動脈の左バルサルバ洞起始症の1例を経験したので報告する。

A 51-year old man was admitted to our hospital, because of syncope. During admission, he had three episodes of syncopal attack. During the episodes, monitor ECG showed two times of ventricular tachy-cardia and one of paroxysmal A-V block.

The left ventriculogram showed dilatation of left ventricle with posterobasal aneurysm, anterobasal and apical hypokinesis. The left coronary artery was normal. The right coronary artery originated from the left sinus of Valsalva and passed through between aortic root and pulmonary trunks. There was no atherosclerotic lesions in both coronary arteries.

Non-sustained ventricular tachycardia was induced by triple premature stimulations. The inverse rela-tion between the coupling interval of premature stimu-lation and the echo interval was recognized. Lido-caine (50 mg IV), Flecainide (300 mg/day), Mexi-letine (450 mg/day), and Aprindine (60 mg/day) pre-vented ventricular tachycardia. Rapid atrial pacing induced paroxysmal A-V block.

Permanent pacemaker was implanted because of syncope due to paroxysmal A-V block and ventricular tachycardia was prevented by Aprindine.

Recently, the case with anomalous origin of the coro-nary artery increased by the popularization of coro-nary angiography. But, this case considered to be rare because of complication with ventricular aneurysm and lethal arrhythmia (ventricular tachycardia and paroxysmal A-V block).