大動脈弁交連部剝離による急性大動脈弁閉鎖不全症の1例

Acute Aortic Insufficiency due to the Avulsion of Aortic Valve Commissure；Report of a Case

はじめに　急性大動脈弁閉鎖不全症（AR）は一般的に感染性心内膜炎，大動脈解離，鈍的胸部外傷に関連するが，弁の穿孔破裂や交連部剝離により生じる場合もある1，2）．本疾患は治療の有無にかかわらず予後がわるく，根治的治療は外科手術だけである．われわれは自然発症した大動脈交連部剝離による急性ARを経験したので報告する．

A 61-year-old man with a history of hypertension and cerebral infarction, presented to a clinic with sudden dyspnea at rest. He was diagnosed with heart failure and referred to our hospital. Echocardiography and three-dimensional computed tomography showed acute heart failure and aortic insufficiency due to avulsion of the aortic valve commissure between the right coronary cusp and the non-coronary cusp. He had no symptoms such as fever or infection and no history of rheumatic disease. He underwent intima fixation of the avulsed commissure and aortic valve replacement using a tissue valve because acute left heart failure was refractory to medical treatment. Postoperative echocardiography demonstrated good left ventricular contraction without any aortic regurgitation. He was discharged on the 35th postoperative day.