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英文誌(2004-)

Journal of Medical Ultrasonics

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1986 - Vol.13

Vol.13 No.01

Case Report(症例報告)

(0057 - 0063)

拡張中∼終期左右心室間短絡雑音を伴った急性心筋梗塞後心室中隔穿孔の1例:パルス・ドプラ一法による成因の検討

Phono- and Pulsed Doppler Echocardiographic Studies on the Long Durated Diastolic Murmur due to Diastolic Left-to-Right Shunt in a Patient with Ventricular Septal Rupture Following Acute Myocardial Infarction

福田 信夫, 大木 崇, 富永 俊彦, 苛原 恵子, 三河 哲也, 大櫛 日出郷, 森 博愛

Nobuo FUKUDA, Takashi OKI, Toshihiko TOMINAGA, Keiko IRAHARA, Tetsuya MIKAWA, Hidesato OKUSHI, Hiroyoshi MORI

徳島大学医学部第二内科

The Second Department of Internal Medicine, Faculty of Medicine, University of Tokushima

キーワード : Ventricular septal rupture, Long durated diastolic murmur, Diastolic left-to-right shunt, Pulsed Doppler echocardiography

 We reported a case with long durated diastolic murmur due to diastolic left-to-right (l-r) shunt associated with ventricular septal (VS) rupture following acute myocardial infarction. The murmur started around the third heart sound and continued to end-diastole, then it was crescendo in configuration and was followed by the pansystolic murmur of VS rupture. The point of maximum intensity of the murmur was exactly same as that of the pansystolic murmur. The murmur was recorded mainly in the high frequency range of the phonocardiogram (PCG).
 Systolic turbulent flow and diastolic unidirectional flow toward the right ventricle, indicating systolic and diastolic l-r shunts respectively, were detected by pulsed Doppler echocardiography (PDE) with the sample volume along the right surface of the VS consistent with the rupture. Diastolic shunt flow signal was coincident in timing with the diastolic murmur. Mid- to end-diastolic pressure gradient between right and left ventricles was observed. This diastolic murmur, therefore, seemed to be due to diastolic l-r shunt.