正常冠動脈造影像を示した心筋梗塞後心尖部心室瘤に圧較差を認めた1例

Post infarction apical aneurysm with pressure gradient between aneurysm and normal left ventricular cavity and with normal corollary arteriogram

　心筋梗塞は冠動脈の動脈硬化性病変を基盤として発症するものが大部分であるが，近年選択的冠動脈造影の普及により冠動脈に有意な狭窄性病変の認められない心筋梗塞も多数^1〜8）報告されるようになってきた。一方，正常冠動脈の心筋梗塞で心室瘤を形成する頻度は非常に稀ではあるが徐々に報告例が増加^9〜12）してきた。

　今回我々は，正常冠動脈に発生した心筋梗塞後心尖部心室瘤において，心室瘤・正常左室腔間に収縮期圧較差の認められた興味ある1例を経験したので報告する。

We report a case of post infarction apical aneurysm with pressure gradient (40 mmHg) between aneurysm and normal left ventricular cavity and with normal coronary arteriogram.

A 40-year-old man developed a typical myocardial infarction on Oct. 29, 1983. ECG showed ST elevation in leads II, III and aVF. He was admitted to our hospital for futher evaluation of his heart condition on Nov, 24 1983. Coronary arteriogram showed no significant stenosis in both right and left coronary arteries. Left ventriculogram showed apical aneurysm. Left side cardiac catheterization demonstrated 40mmHg pressure gradient between normal left ventricularcavity and aneurysm. UCG showed no ASH nor SAM.

Septal biopsy showed no specific findings. These findings denied the diagnosis of HOCM in this case.