神奈木 俊子, 中村 正治, 山元 明子, 高橋 正明, 安永 公平正, 琴浦 肇, 河合 忠一

Toshiko KANNAGI, Masaharu NAKAMURA, Akiko YAMAMOTO, Masaaki TAKAHASHI, Koheisho YASUNAGA, Hajime KOTOURA, Chuichi KAWAI

京都大学医学部第三内科

Third Division, Department of Internal Medicine, Faculty of Medicine,Kyoto University

キーワード : annulo-aortic ectasia, suprasternal two-dimensional echocardiogram, dissecting flap, prolapsed aortic valve

In a 23-year-old female with Marfan's syndrome and aortic regurgitation, parasternal two-dimensional echocardiography demonstrated an undulating flap at the posterior wall of the enlarged aortic root.
A suprasternal view showed a similar structure in the aortic arch proximal to the left subclavian artery. The flap moved posteriorly in systole and anteriorly in diastole. M-mode echogram of the aortic valve showed early systolic partial closure and systolic fluttering of the right and noncoronary cusps and multiple echoes in diastole due to the prolapsed noncoronary cusp. Prolapse of the anterior mitral leaflet was also seen. The echocardiogramphic diagnosis of dissecting aortic aneurysm was confirmed by aortography. The movement of the flap was reduced after oral propranolol therapy. In a 35-year-old male with Marfan's syndrome, a dissecting flap was seen in the abdominal aorta on two-dimensional echocardiography. It also moved posteriorly in systole, but its onset of posterior movement was somewhat later than that of the proximal flap in case 1. Two-dimensional echocardiography was more useful in detecting the thin dissecting flap than other methods such as radionuclide angiography or computed tomography.