収縮期雑音のみを伴つた純型僧帽弁狭窄症の1例

A Case of Pure Mitral Stenosis with Systolic Murmur

I．緒言

　我々は最近心尖部に拡張期雑音を全く欠き，強い収縮期雑音のみを聞いた非定型的僧帽弁狭窄症を経験し，手術により確かめ得たので報告し，併せて心音を中心とした僧帽弁狭窄症の診断に就き文献的考察を加えて見たい。

This is a case of atypical pure mitral stenosis seen in 17-year-old female. The physical examination revealed marked congestive heart failure and there was loud systolic murmur best heard at the apex, but without diastolic murmur. Chest X-ray examination showed congestion of the both lung fields and marked enlargement of the cardiac silhouette. Elec-trocardiographic findings were right axis deviation, diphasic P wave and right ventricular hypertrophy pattern. phonocardiogram showed holosystolic murmur best noticed at the apex with obvious prolongation of Q-I interval and opening snap which occured 0.05 seconds later than the second sound.

At first, congestive heart failure based on mitral insufficiency was suspected, but later mitral stenosis could not be denied because of electrocardiographic and phonocardiographic findings.

Since it became evident at the operation that she was found to have pure mitral stenosis, but unfortunately the patient expired.

Diagnosis of mitral stenosis was made by past history, physical examination, chest X-ray findings, electrocardiogram and phonocardiogram, but accurate diagnosis of this type of dis-ease is not always easy.

Recently several investigator have stressed the importance of phonocardiographic analysis of mitral stenosis by which could determine even the severity of the disease. Atypical mitral stenosis is discussed with special reference to phonocardiogram.