村松 俊裕¹, 築井 均¹, 宮本 直政¹, 崔 正哉¹, 芹澤 剛¹, 松尾 博司¹, 俊鋭 許², 尾本 良三²

Toshihiro MURAMATSU¹, Hitoshi TSUKUI¹, Naomasa MIYAMOTO¹, Masaya SAI¹, Takashi SERIZAWA¹, Hiroshi MATSUO¹, Kyo SHUNEI², Ryozo OMOTO²

¹埼玉医科大学第2内科, ²埼玉医科大学第1外科

¹Second Department of Internal Medicine, Saitama Medical School, ²First Department of Surgery, Saitama Medical School

キーワード : Acute allograft rejection, Echocardiographic findings, Heart transplantation

No method for detecting cardiac rejection or noninvasively evaluating the effects of antirejection therapy has yet been established. Deterioration of mitral regurgitation, worsening of systolic function, and reduction in ventricular compliance are some echocardiographic findings that have been suggested to reflect rejection, however. We observed a unique thickening in the ventricular septum of the cardiac transplanted patient during the time course of cardiac allograft rejection. The case discussed here is that of a 45-year-old man with end-stage heart failure resulting from idiopathic dilated cardiomyopathy. He had had heart transplantation in Germany on July 13, 1995. We followed this patient with conventional immunosuppression therapy in our cardiology clinic and found abnormal wall thickening of the ventricular septum on echocardiography 6 months after the transplantation. Grade of septal wall thickening appeared to be closely correlated with that of diastolic dysfunction as estimated by the left ventricular (LV) inflow pattern. Echocardiography showed decreased LV ejection fraction and diastolic dysfunction on his latest visit to the clinic, but ECG detected no significant abnormalities. We diagnosed this as rejection and started steroid pulse therapy immediately. We followed the rejection with echocardiography and found restoration of LV systolic and diastolic function and septal wall thickening after what proved to be successful steroid pulse therapy. Reduction in LV filling parameters resulting from LV restrictive impairment is generally thought to be closely associated with grade of rejection. We found the increase in LV filling parameters to have been caused by obvious LV ventricular thickening. This observation may reflect a pattern of echocardiographic findings different from those associated with previously reported cases of rejection.