高齢者の筋性部心室中隔欠損症に対する手術の1例

Ventricular Septal Defect in an Elderly Patient：Report of a Case

はじめに　日本の成人先天性心疾患（ACHD）レジストリ（JNCVD-ACHD）に登録された集計データによれば，全ACHD患者9,743例中65歳以上の患者は1,063例で，約11％を占める1）．この65歳以上の高齢ACHD患者における疾患の内訳をみると，心房中隔欠損症（ASD）が54.4％ともっとも多く，次いで心室中隔欠損症（VSD）が11.9％を占めている1）．さらに治療歴については，65歳以上の高齢VSD患者に限ると，54.3％で未修復の状況である．

Ventricular septal defect （VSD） is one of the most common congenital heart diseases, but untreated cases reaching advanced age are rare. We report a case of an 85-year-old woman with an untreated VSD who presented with dyspnea. Despite the relatively large defect （12×16 mm）, she had no prior history of heart failure. Echocardiography and catheterization revealed a left-to-right shunt with mild pulmonary hypertension. Surgical closure was performed using a Dacron patch, and the patient had a favorable postoperative course. The absence of early heart failure was likely due to a hypertrophied trabecular muscle partially covering the defect, limiting the left-to-right shunt. However, as right ventricular hypertrophy progressed, the defect widened, leading to acute heart failure. This case highlights the potential for long-term survival in patients with specific anatomical modifications and underscores the importance of individualized surgical decision-making in elderly VSD patients.