Valsalva洞動脈瘤の冠状動脈圧迫により発症したと思われる心筋梗塞の1例

A case of acute myocardial infarction possibly caused by Valsalva aneurysm of the right and noncoronary sinuses

　Valsalva洞動脈瘤の多くは先天性であり，健康診断等で偶然発見される場合を除いては，動脈瘤の破裂により発見される場合が多い。今回我々は，健康診断で見つかり，経過観察中に，Valsalva洞動脈瘤の右冠状動脈圧迫により，心筋梗塞を発症したと思われる1例を経験したので報告する。

This is a 62 year old, thin and tall, male patient who developed acute myocardial infarction possiblycaused by Valsalva aneurysm associated with Mar-fan syndrome. The patient first noticed exertional dyspnea in 1971 and cardiac hypertrophy associated with atrial fibrillation was subsequently diagnosed in 1979. One year later, Valsava aneurysm with aortic regurgitation was confirmed by x-ray CT, RI angiography and echocardiography.

On August 5th, 1982, while working, the patient developed severe precordial pain and cold sweating lasted for several hours. Two weeks later, the patient was admitted to the cardiology department, Chiba University Hospital and inferior myocardial infarction was confirmed by the findings of serial cardiac enzymatic, electrocardiographic and RI scintigraphic studies. After completion of the car-diac rehabilitation program, the surgical operation was performed at Mitsui Memorial Hospital. Atthe surgery, it was confirmed that an aneurysm with 10cm diameter originating from the right coronary and noncoronary sinuses compressed the right coronary artery and aortic valve dilatation caused aortic regurgitation. Aortoplasty and artifi-cial aortic valve replacement were successfully per-formed and the postoperative course was unevent-ful.

Since the serological test for syphilis was negative and the histological study did not disclosed inflam-matory changes, but severe fragmentation, atrophy and disappearance of elastic fibers in the resected aneurysmal wall, the diagnosis was thought to be compatible with an incomplete type of Marfan syndrome. The patient has been entirely free from any cardiac symptom after the surgery.