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.