無症候に心筋梗塞症を発症し，心室中隔穿孔後も長期間無症状であった1例

A Case of Ventricular Septal Perforation with a Long term Asymptomatic Period after Painless Acute Myocardial Infarction

　無症候に心筋梗塞を発症し心室中隔穿孔を生じた後も長期間にわたって無症候に経過した稀な症例を報告する．症例は66歳，男性．健康診断目的に愛媛大学病院を受診し下壁梗塞と心室中隔穿孔を指摘され，加療目的にて当院紹介となった．入院時には心不全症状を全く認めなかった．心電図では下壁誘導に陰性T波と異常Q波を認めた．右心カテーテル検査では肺動脈収縮期圧は60mmHg，右室での酸素飽和度の上昇を認め，左右短絡率は55％であった．冠動脈は後下行枝の完全閉塞と左冠動脈主幹部と左前下行枝近位部にそれぞれ50％の狭窄を認めた．穿孔部の閉鎖術および左前下行枝に対するバイパス術を待機的に施行した．穿孔は心室中隔後部にあり径は約5mmで，穿孔部周囲は器質化していた．

We report a rare case having no symptoms over a long-term period after onset of acute myocardial infarc-tion and ventricular septal perforation.

A 66-year-old man who visited the Ehime University Hospital for medical examinations was diagnosed as hauing ventricular septal perforation with inferior myocardial infarction. He was brought to our hospital for treatment. On admission he had no symptoms sug-gesting heart failure. His electrocardiogram showe abnormal Q wave and negative T wave in the inferio leads. At cardiac catheterization, systolic pulmonary arterial pressure was 60mmHg, there was a step-up in oxygen saturation in the right ventricle, and left-to right shunt rate was 55%. His coronary angiogram demonstrated total occlusion at the right posterior descending artery and 50% stenosis at the left main trunk and proximal site of the left anterior descending artery. Closure of the perforation and coronary bypass grafting to the left anterior descending artery were performed effectually. The defect located on the poste-rior interventricular septum was 5mm in diameter in-cluding cicatrization.