相田 健次¹, 木下 美菜子¹, 佐藤 信浩², 吉開 友羽子¹, 山根 啓一郎¹, 吉野 直樹¹, 川戸 充徳¹, 江尻 純哉¹, 永澤 浩志¹, 小山 忠明³

Kenji AIDA¹, Minako KINOSHITA¹, Nobuhiro SATO², Yuko YOSHIGAI¹, Keiichiro YAMANE¹, Naoki YOSHINO¹, Mitsunori KAWATO¹, Junya EJIRI¹, Hiroshi EIZAWA¹, Tadaaki KOYAMA³

¹西神戸医療センター循環器内科, ²西神戸医療センター臨床検査部, ³神戸市立医療センター中央市民病院心臓血管外科

¹Department of Cardiovascular Medicine, Nishi-Kobe Medical Center, ²Clinical Laboratory, Nishi-Kobe Medical Center, ³Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital

キーワード : raphal cord, acute severe aortic regurgitation, bicuspid aortic valve, 3D transesophageal echocardiography

症例は56歳の女性，主訴は胸部違和感．2週間前より咳嗽が出現し，胸部違和感と動悸を自覚したため当院を受診，精査加療目的に入院となった．来院時，脈圧の開大とSpO2の低下を認め，Levine III/VIの拡張期逆流性雑音を聴取した．胸部Ｘ線では，両側に肺うっ血，胸水貯留を認めた．心エコー図検査にて大動脈二尖弁（BAV）と重度の大動脈弁閉鎖不全症（AR）を認め，さらに弁尖に付着する索状構造物が見られたため，感染性心内膜炎（IE）を疑ったが，発熱はなく血液培養も陰性であった．重症ARによるうっ血性心不全で手術適応と判断し，他院にて大動脈弁置換術を施行した．術中所見ではrapheと連続する索状構造物（raphal cord）が断裂していた．急性ARの主な原因は，IEと急性大動脈解離であるが，今回，我々はraphal cordの断裂による急性ARを経験し，その診断に経胸壁および経食道心エコー検査が有用であったので報告する．

A 56-year-old female was admitted to our hospital with a history of cough, chest discomfort, and palpitation for 2 weeks. Diastolic murmur (Levine 3/6) and hypoxemia were found. Chest X-ray showed pulmonary congestion and pleural effusion. Transthoracic echocardiography and transesophageal echocardiography demonstrated bicuspid aortic valve and severe aortic regurgitation, with a mobile fibrous band adhering to the valve leaflet. Infective endocarditis was excluded by negative blood culture and afebrile condition. Emergent aortic valve replacement was performed because of uncontrollable heart failure. A ruptured fibrous strand (raphal cord) was found during the operation. Major causes of acute aortic regurgitation are infective endocarditis and aortic dissection. Acute aortic regurgitation due to ruptured raphal cord is rare. Transthoracic echocardiography and transesophageal echocardiography were useful for differential diagnosis of acute aortic regurgitation.