無痛性限局性大動脈解離による重症急性大動脈弁閉鎖不全の1例

A Case Study of Severe Acute Aortic Valve Regurgitation caused by Painless Mild Dissection of the Ascending Aorta

要旨

　患者は64歳，女性．1カ月前よりの労作時呼吸困難を主訴に来院．来院時，低酸素血症と胸部単純写真上で両肺野にうっ血像を認め，急性左心不全と診断した．入院後，心エコー，心臓カテーテル検査により，その原因は重症大動脈弁閉鎖不全症(AR)であり，左室容量が増大していないことより急性ARと考えた．カテコラミン，利尿剤で循環血行動態を安定させた後，第17病日に大動脈弁置換術を行ったところ，弁の直上に限局性の大動脈解離があり，急性ARの原因と推察された．無痛性限局性大動脈解離による急性ARは極めて稀であり，診断が困難であることが多く，早期に手術することが必要であると考えられる．

A-64-year old female was admitted to our hospital with severe symptoms of exertional dyspnea without chestpain. Atthattime,shewasinastateofacuteleft-sided heart failure,hypoxic and,upon chest X ray,she was found to have a bilateral congestion shadow. The echocardiogram and cardiac catheterization revealed severe aortic valve regurgitation. Because the left ventricular volume was not increased,the regurgitation was considered acute.

　Infusion of dopamine and diuretics provided adequate stabilization of the haemodynamic condition,so an aortic valve replacement was undertaken on the 17^th day after admission. The dissection appeared to be above the aortic valve and was limited in scope.

　We concluded that the acute aortic regurgitation was caused by aortic dissection,a rare condition difficult to diagnose. Prompt surgical treatment is required.