抜管後の急性心不全の診断時に発見された大動脈四尖弁の1症例

A Diagnosed Case of Quadricuspid Aortic Valve during Unexpected Acute Heart Failure after Extubation

要旨

　抜管後にクリニカルシナリオ1の急性心不全を来し，集中治療室入室後の経胸壁心エコー検査で大動脈弁閉鎖不全を伴う大動脈四尖弁を指摘された50代女性の症例を経験した。冠動脈奇形を合併することもある大動脈四尖弁はまれな先天性心疾患ではあるが，誘因なく周術期に生じる急性心不全の原因となることがある。

　Quadricuspid aortic valve（QAV）, a rare congenital aortic valve disease, may cause aortic insufficiency and heart failure. A female patient in her 50s presented with acute heart failure after she recovered from general anesthesia and extubation after laparoscopy. Transthoracic echocardiography revealed moderate-to-severe aortic insufficiency and QAV. The patient’s symptoms improved with respiratory management using noninvasive positive pressure ventilation（NPPV）and the administration of diuretics.

　QAV can be associated with coronary artery malformation, and we thus concluded that when acute heart failure occurs in patients without an unknown cause, QAV should be considered and an extra-careful examination must be performed.