大動脈弁逸脱による弁逆流を合併したacromegalic heartの1例

A Case of Acromegalic Heart Associated with Aortic Regurgitation due to Aortic Valve Prolapse

　acromegalyは心疾患を合併することが知られているが，acromegalyと弁膜症に関する報告は散見されるものの大動脈弁逸脱症を合併したという報告は未だない．今回われわれは大動脈弁逸脱を合併したacromegalic Heartの1例を経験した．症例は46歳，女性．来院時呼吸困難があり心不全にて入院．血中成長ホルモン値が330ng／mlと高値を示し，頭部MRIにて下垂体腫瘍を認め，acromegalyによる心不全と考えられた．心臓超音波検査にて左室の肥大，拡大，壁運動の低下および大動脈弁無冠尖の逸脱によるII度の大動脈弁逆流を認めた．また僧帽弁に異常所見は認めなかった．内科的治療法にて心不全改善後，下垂体腫瘍摘除術を施行し，成長ホルモン値は35ng／mlまで低下した．大動脈弁逸脱の原因として弁の粘液変性および大動脈内の慢性的な圧負荷が脆弱した弁にかかったためである可能性が推察された．

Cardiovascular disease is common in patients with acromegaly. However, valvular heart disease has rare-ly been reported in patients with acromegaly, and there has been no report of acromegaly with aortic valve plolapse (AVP). A 46-year-old woman, who had com-plained of dyspnea on effort for several years, visited our hospital because of worsening of symptoms. The serum level of growth hormone was 330ng/ml. The diagnosis was congestive heart failure (CHF) due to acromegaly. Left ventricular (LV) hypertrophy, LV dilatation, decreased LV function, and aortic regurgita-tion due to AVP of the non-coronary cusp (NCC) were identified on echocardiographic examination. CHF responded to conventional medical therapy, including diuretics and vasodilators. The AVP in this patient was attributed to myxomatous degeneration of the aortic valve and chronic intra-aortic blood-pressure load on the fragile aortic cusp.