Izawa Atsushi, Sekimura Noriyuki, Uchikawa Shin-ichiro, Yazaki Yoshikazu, Kinoshita Osamu, Owa Mafumi, Kubo Keishi, Ikeda Uichi, Sekiguchi Morie, Kitahara Hiroto, Amano Jun, Imamura Hiroshi
First Department of Internal Medicine, Shinshu University School of Medicine, Nagano, Japan.
Int Heart J. 2005 Jan;46(1):167-74. doi: 10.1536/ihj.46.167.
A male patient with tetralogy of Fallot accompanied by aortic regurgitation had maintained sufficient exercise capacity for a number of decades with the status of acyanotic tetralogy of Fallot. When he was 67 years old, he suffered a posterior wall acute myocardial infarction and direct percutaneous coronary angioplasty successfully revascularised the target lesion in the left circumflex artery. However, a few months after the onset of the myocardial infarction, his shortness of breath became clinically significant and was associated with increased right-to-left shunt and increased right ventricular end-diastolic pressure, as well as hypoxia. At 68 years old, therefore, total corrective repair of the tetralogy with replacement of the aortic and pulmonary valves was performed. The patient was asymptomatic after the successful operation. This report suggests that coronary artery disease can be one of the potential factors in inducing critical hemodynamic changes in aging patients with congenital heart disease, especially those who have a shunt between the right and left chambers. The unique clinical course is described with some discussion of the repair of tetralogy in adults.
一名患有法洛四联症并伴有主动脉瓣反流的男性患者，在数十年间一直保持着充足的运动能力，处于无青紫型法洛四联症状态。67岁时，他发生了后壁急性心肌梗死，直接经皮冠状动脉血管成形术成功使左旋支动脉的靶病变血管再通。然而，心肌梗死后几个月，他的气短在临床上变得显著，且与右向左分流增加、右心室舒张末期压力升高以及缺氧有关。因此，在68岁时，对该四联症进行了全面矫正修复，并置换了主动脉瓣和肺动脉瓣。手术成功后患者无症状。本报告提示，冠状动脉疾病可能是导致老年先天性心脏病患者，尤其是那些左右心室之间存在分流的患者出现严重血流动力学变化的潜在因素之一。文中描述了这一独特的临床过程，并对成人法洛四联症的修复进行了一些讨论。
