高度の流出路圧較差を呈したsigmoid septumの1症例

Abstract

An 83-year-old woman was referred to our hospital for the treatment of epidermoid pemphigus. She had a history of hypertension since the age of fifty years and had been receiving an anti-hypertensive medication from a private clinic for the last few years. Physical examination showed a systolic ejection murmur (Levine 3/6) at the apex. An electrocardiogram showed high voltage in the left lateral chest leads. A chest roent- genogram showed that the thoracic aorta was severely tortuous. Laboratory data on admission revealed mild anemia and elevation of C-reactive protein. An echocardiogram revealed that the base of the interventricular septum protruded toward the left ventricular outflow tract and showed a sigmoid appearance. The angle between the midline of the interventricular septum and that of the aortic root was 70°. Left ventricular outflow blood velocity was 3.5 m/s, and the outflow pressure gradient appeared to be 50 mmHg. Although a sigmoid septum usually does not give rise to serious clinical problems, a significant left ventricular outflow pressure gradient may develop.