Yokoya Takahiro, Moromikawa Jun, Uehara Kazuhiro, Nakada Kiyonobu, Kuba Masaaki, Zaha Masami
Division of Cardiology, Okinawa Kyodo Hospital, Madanbashi 593-1, Tomigusukuson, Shimajiri-gun, Okinawa 901-0293.
J Cardiol. 2002 Oct;40(4):167-72.
A 73-year-old woman with a left femoral neck fracture underwent an operation for femoral caput replacement. Twenty-five minutes after induction of spinal anesthesia, ST depression emerged followed by shock. Although the ST depression indicated an ischemic event, Levine grade IV systolic murmur was noticed at the aortic valve area. Echocardiography revealed narrowing of the left ventricular outflow tract with a pressure gradient of 170 mmHg. Rapid fluid infusion (1,000 ml) stabilized her blood pressure and the patient recovered without adverse sequelae. Echocardiography and magnetic resonance imaging suggested the presence of sigmoid shaped ventricular septum rather than obstructive hypertrophic cardiomyopathy. There was no significant pressure gradient at rest. Sigmoid shaped ventricular septum is usually considered as a normal aging process and has little clinical importance, but several cases associated with outflow obstruction have been reported. As the patient had no abnormal findings on electrocardiography or chest radiography and had no abnormal symptom on physical examination, the sequelae were impossible to predict.
一名73岁左侧股骨颈骨折女性接受了股骨头置换手术。脊麻诱导后25分钟，出现ST段压低，随后发生休克。尽管ST段压低提示缺血事件，但在主动脉瓣区可闻及4级 Levine 收缩期杂音。超声心动图显示左心室流出道狭窄，压力阶差为170 mmHg。快速输注液体（1000 ml）使她的血压稳定，患者康复且无不良后遗症。超声心动图和磁共振成像提示存在乙状结肠形室间隔而非梗阻性肥厚型心肌病。静息时无明显压力阶差。乙状结肠形室间隔通常被认为是正常的衰老过程，临床意义不大，但已有数例与流出道梗阻相关的病例报道。由于该患者心电图和胸部X线检查无异常发现，体格检查也无异常症状，因此无法预测后遗症。
