潰瘍性大腸炎を合併した大動脈炎症候群にBentall手術を施行した1例

A Case of Bentall's Operation for Aortitis Syndrome Associated with Ulcerative Colitis

　1997年に潰瘍性大腸炎と診断され，薬物治療を受けていた患者（24歳，女性）が，呼吸苦を主訴に来院した．入院時，潰瘍性大腸炎の症状は落ち着いていたものの，炎症所見があり，心エコー図検査で重度の逆流を伴う大動脈弁閉鎖不全症を認めた．胸部CTおよび胸部MRA検査で，大動脈基部から上行大動脈にかけての拡大があり，大動脈炎症候群による大動脈弁閉鎖不全症と診断し，Bentall手術を行った．両疾患の合併例は，HLA-B52,DR 2が高頻度に認められており，本症例も同様であった．日本人では，HLA-DR 2がB52とリンクし，共通する免疫遺伝学的背景があると考えられている．潰瘍性大腸炎の経過中に大動脈炎症候群を併発する可能性があり，注意が必要である．

A 24-year-old woman was admitted to our hospital due to dyspnea. The patient had been diagnosed as having ulcerative colitis 2 years previously and was treated with sulfasalazine.

On adimission, symptoms of ulcerative colitis were stable, but laboratory investigation demonstrated inflammatory changes and trans-thoracic-echocardio-graphy revealed severe aortic regurgitation. Chest computed tomograpy and magnetic resonance angiogra-phy showed dilatation of the sinuses of Valsalva and of the proximal ascending aorta. As it was supposed that annuloaortic ectasia due to aortitis syndrome resulted in severe aortic regurgitation, Bentall's operation was perfomed. Because the HLA formes Bw 52 and DR 2 are occasionally found in Japanease patients including this present case with aortitis syndrome and ulcerative colitis, both of the diseases may be associated with some kind of immunogenetic abnormality. Thus, we should be aware of possible complications such as aortitis syn-drome in the clinical course of ulcerative colitis.