住野 裕子¹, 竹内 陽史郎², 武本 真由美¹, 村上 楓佳¹, 小川 莉沙¹, 津田 清³

Yuko SUMINO¹, Yoshio TAKEUCHI², Mayumi TAKEMOTO¹, Fuka MURAKAMI¹, Risa OGAWA¹, Kiyoshi TSUDA³

¹神戸協同病院検査科, ²竹内医院, ³神戸協同病院内科

¹Laboratory, Kobe-kyoudou Hospital, ²Takeuchi Clinic, ³Internal Medicine, Kobe-kyoudou Hospital

キーワード : Doppler echocardiography, anomalous great cardiac venous drainage, persistent left superior vena cava

症例は90歳代女性．心房細動の基礎心疾患精査のために行われた心エコー図検査にて，左房天蓋部から大動脈後方を通り，心房中隔上部に還流する連続性の血流シグナルを認めた．パルスドプラ法による血流速パターンは収縮末期に1.9 m/secのピークを有し，拡張期は0.9 m/secの連続性の血流速パターンを示し，冠静脈の血流速パターンと一致していた．その解剖学的走行は，過去に報告されている大心静脈還流異常症と一致していた．後日，冠動脈CTにて大心静脈の還流異常を確認できた．また，左上肢からのコントラストエコーにて左上大静脈遺残の合併も診断できた．以上，心エコー図法を用いて，極めてまれな冠静脈奇形である大心静脈還流異常症を診断できたので，ここに報告した．

A woman in her nineties was referred to our laboratory for further examination of her underlying cardiac disease, i.e., atrial fibrillation. Color Doppler echocardiography showed tubular continuous flow coming from between the top of the left atrium and ascending aorta, draining into the right atrium near the fossa ovalis. Doppler examination of this flow showed a continuous flow wave with a prominent systolic flow component (1.9 m/sec), followed by a slow diastolic flow component coincident with the flow profile of the coronary vein. Considering the anatomical bloodstream and Doppler profile of this flow, we diagnosed this flow as anomalous great cardiac venous drainage (AGCVD), which is a rare coronary venous anomaly. This diagnosis was confirmed by the coronary CT findings. Contrast echocardiography from the left arm revealed persistent left superior vena cava. This is the first case report of AGCVD diagnosed using Doppler echocardiography in the literature.