右室流出路狭窄を伴った非破裂Valsalva洞動脈瘤の一例

A case of unruptured aneurysm of the sinus of Valsalva producing right ventricular outflow obstruction

　後天性肺動脈弁狭窄症は右室内の腫瘍，あるいは心臓外よりの右室流出路の圧迫により生じると報告されている^1）。非破裂Valsalva洞動脈瘤でVSDの合併のない右室流出路狭窄症例の報告は非常にまれである。我々は肺動脈弁狭窄症の疑いにて心臓カテーテル検査を実施した症例において，肺動脈弁下狭窄の原因が非破裂Valsalva洞動脈瘤による右室流出路圧迫であると判断し，動脈瘤切除術を行い確認しえた症例を経験したので報告する。

We experienced a patient with right ventricular outflow obstruction due to an unruptured aneu-rysm of the sinus of Valsalva. Case was a 34-year-old man with a episode of dyspnea. He was admit-ted to our clinic for further evaluation of precordial heart murmur which was pointed out 10 years previously. On auscultation, a grade 5/6 crescendo-decrescendo systolic murmur was best heard at the third left intercostal space. Chest X ray film, elec-trocardiogram revealed no abnormalities. Other laboratory studies were also within normal limits. Cardiac catheterization indicated marked elevation of right ventricular systolic pressure, with a 50 mmHg gradient between the body of the right ventricle and the pulmonary artery. Subvalvular pulmonic stenosis was clearly demonstrated by simultaneous right ventricle and pulmonary artery tracing. Multiple oxygen determinations from the various cardiac chambers did not suggest intracar-diac shunting. Aortogram revealed a large aneu-rysm of the right sinus of Valsalva projecting into and obstructing the right ventricular outflow tract. Because of progressive symptomatology, severe in-fundibular pulmonic stenosis and the presence of a large sinus of Valsalva aneurysm, with the possi-bility of later rupture into the right ventricle, Valsalva aneurysm was resected and path closure. The aneurysm had not ruptured, and no associated ventricular septal defect was present.