術後10年を経過したDiscrete型大動脈弁下狭窄症

A ten year follow-up of surgically treated discrete subvalvular aortic stenosis

　Discrcte型大動脈弁下狭窄症は，本邦では比較的稀で，狭窄の急速な進行が特徴であり．左室負荷の解除．大動脈弁閉鎖不全症及び感染性心内膜炎^1）の予防の上からも，早期手術が望ましい。

　教室では約4,600例の先天性心疾患中1例（0.02％）のみの経験であり，本症術後10年目のカテーテル検査所見を得たので，その長期予後を報告する。

A 21 years old man was admitted to our clinic for evaluation of cardiac murmur and vertigo. Pa-tient was first pointed out cardiac murmur at the age of six and became to complain exertional ver-tigo at the age of eleven. A left ventricular to aor-tic peak systolic gradient was 112mmHg. Left ven-triculography revealed a thin nonopacified line be-low the aortic valve. So the diagnosis of discrete subvalvular aortic stenosis was confirmed. Subaor-tic thick membrane was resected through transaor-tic approach. Pathological finding of resected mem-brane was dense fibrosis. Catheterization after one month operation revealed that pressure gradient was decreased to 32mmHg.

Ten years postoperatively patient was readmitted for evaluation of convulsion at night. The pressure gradient was 40mmHg and left ventricular contrac-tion was also good (Ejection fraction: 63%, Car-diac index: 3.43l/min/m²). Epilepsy was diagnos-ed by electroencephalogram. Patient is doing well under the medication for epilepsy.