術前の心エコー所見と手術時所見に不一致をみた特発性腱索断裂に伴う僧帽弁逸脱症の1治験例

A Case of Mitral Valve Prolapse Caused by Idiopathic Ruptured Chordae Tendineae : Comparison with two dimensional echocardiographic features and surgical findings of flail mitral leaflets

　症例は47歳，男性．主訴は労作時の息切れ，動悸．入院3カ月前に初めて心雑音を指摘されていた．入院時全収縮期雑音を聴取し，胸部X線写真で軽度の心拡大，肺うっ血および胸水貯留を呈し，心電図では洞性頻脈と両房負荷を示した．心エコー検査（経胸壁，経食道）にて僧帽弁前尖および後尖の一部（medial scallop）の逸脱と腱索断裂，それに伴う高度の僧帽弁逆流が観察された．左室造影では僧帽弁前尖の逸脱と逆流所見が認められた．手術適応との判断で僧帽弁形成術が施行されたが，術中所見では僧帽弁後尖に連なる腱索の断裂と後尖のみの逸脱であった．本例は術前の心エコー診断と術中所見が一致しなかった例であり，その原因につき若干の考察を加え報告した．

A 43-year- old man was admitted to our hospital because of shortness of breath on exertion and palpita-tion. Heart murmur was pointed out 3 months prior to the admission. Chest roentgenogram revealed car-diomegaly with pulmonary congestion. Electrocardio-gram showed sinus tachycardia and left atrial overload. Transthoracic and transesophageal echocardiograms revealed prolapse of the anterior and posterior (medial scallop) leaflets of the mitral valve. The abnormal echo protruded into the left atrium during systole.