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英文誌(2004-)

Journal of Medical Ultrasonics

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1998 - Vol.25

Vol.25 No.09

Case Report(症例報告)

(0953 - 0958)

心移植後急性拒絶反応の治療経過を心エコー図にて観察した1例

Echocardiographic Observation of the Clinical Course of Acute Rejection in the Heart Transplanted Patient Before and After Steroid Therapy: A Case Report

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.