| Japanese |
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| Title | 運動負荷201Tl心筋SPECTにて広範囲の心内膜下虚血を呈した冠動脈狭窄のない大動脈弁狭窄症の1例 |
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| Subtitle | 症例報告 |
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| Authors | 馬本郁男*, 杉原洋樹*, 原田佳明*, 志賀浩治*, 中川達哉*, 松原欣也*, 大西和彦*, 中村隆志*, 東秋弘*, 河野義雄*, 勝目紘*, 中川雅夫*, 宮尾賢爾** |
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| Authors(kana) | |
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| Organization | *京都府立医科大学第二内科, **京都第二赤十字病院循環器内科 |
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| Journal | 核医学 |
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| Volume | 29 |
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| Number | 1 |
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| Page | 97-103 |
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| Year/Month | 1992/1 |
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| Article | 報告 |
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| Publisher | 日本核医学会 |
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| Abstract | 「要旨」症例は72歳, 女性. 主訴は労作時の胸痛. 昭和50年頃より大動脈弁狭窄症を指摘されていた. 冠動脈に有意狭窄はなく, 左室壁運動異常も認められなかった. 心臓超音波検査にて左室・大動脈間圧較差は簡易ベルヌーイの式で約100mmHgであった. 運動負荷タリウム心筋SPECT施行時, 胸痛および心電図上虚血性ST変化が出現し, 初期像は遅延像に比べ一過性に"左室内腔拡大および壁厚減少"所見を示した. 大動脈弁置換術後6か月目に同検査を施行したところ, それらの所見は出現しなかった. 一過性の"左室内腔拡大および壁厚減少"は見かけ上の所見であり, 広範囲の心内膜下虚血による心内膜下のタリウムの取り込みの低下所見と推測され, 冠動脈に有意狭窄を認めない大動脈弁狭窄症に出現する胸痛の機序を考察する上で貴重な症例と考え, 報告した. 「I. はじめに」大動脈弁狭窄症に出現する胸痛は冠動脈病変がない場合でも認められる. |
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| Practice | 臨床医学：一般 |
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| Keywords | Aortic valve stenosis, Subendocardial ischemia, Thallium-201 myocardial SPECT. |
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| English |
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| Title | Diffuse Subendocardial Ischemia in a Patient with Aortic Valve Stenosis without Coronary Artery Disease by Exercise 201Tl SPECT |
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| Subtitle | Case Reports |
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| Authors | Ikuo UMAMOTO*, Hiroki SUGIHARA*, Yoshiaki HARADA*, Kouji SHIGA*, Tatsuya NAKAGAWA*, Kinya MATSUBARA*, Kazuhiko OONISHI*, Takashi NAKAMURA*, Akihiro AZUMA*, Yoshio KONO*, Hiroshi KATSUME*, Masao NAKAGAWA*, Kenji MIYAO** |
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| Authors(kana) | |
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| Organization | *Second Department of Medicine, Kobe Prefectural University of Medicine, **Kyoto Second Red Cross Hospital |
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| Journal | The Japanese Journal of nuclear medicine |
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| Volume | 29 |
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| Number | 1 |
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| Page | 97-103 |
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| Year/Month | 1992/1 |
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| Article | Report |
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| Publisher | THE JAPANESE SOCIETY OF NUCLEAR MEDICINE |
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| Abstract | [Summary]A case of aortic valve stenosis without coronary artery disease was confirmed to have diffuse subendocardial ischemia by exercise Thallium-201 myocardial single photon emission computed tomography. A 72-year-old woman, who had been diagnosed as aortic valve stenosis, was admitted because of chest pain during exercise. In cardiac catheterization findings, the patient angiographically had normal coronary arteries and no asynergy of left ventricular wall motion. The peak flow velocity in continuous wave Doppler echocardiography was about 5.0m/sec at aortic valve level, providing a pressure drop of 100 mmHg across a stenotic valve with calculating on a modified Bernoulli equation (PG=4V2). Thallium-201 myocardial SPECT images during exercise showed a transient "dilation and a widespread wall thinning" of left ventricle with apical perfusion defect. Simultaneous electrocardiogram showed further ST depression and the patient had chest pain. In 6 months after aortic valve replacement the patient no longer demonstrated both apical perfusion defect and "wall thinning" in postoperative thallium-201 myocardial SPECT images and also had neither ST depression nor chest pain. Thus; a transient "dilation and wall thinning" of left ventricle in this patient is suspected to be a sign of diffuse subendocardial ischemia. |
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| Practice | Clinical medicine |
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| Keywords | Aortic valve stenosis, Subendocardial ischemia, Thallium-201 myocardial SPECT. |
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