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[一例因梅毒性主动脉炎导致左冠状动脉口阻塞的病例]

[A case of left coronary ostial obstruction due to syphilitic aortitis].

作者信息

Nakashima H, Takahara A, Yoshioka M, Suzuki S, Mori H, Oku Y

机构信息

Department of Internal Medicine, Kohseikai Hospital.

出版信息

Kokyu To Junkan. 1991 Aug;39(8):831-5.

PMID:1925106
Abstract

Coronary ostial stenosis is a rare lesion, which is a complication of syphilitic aortitis, Takayasu's aortitis, aortic valve disease, and familial hypercholesterolemia. We present a case of left coronary ostial obstruction due to syphilitic aortitis. A 67 years old man was admitted to our hospital for evaluation of a ten year history of angina on exertion. On physical examination, the only abnormal finding was a grade 2/6 high-pitched diastolic murmur. Coronary risk factor was not detected from biochemical results, but both the TPHA and FTA-ABS test were positive. Treadmill stress test showed more than 2 mm ST segment depression associated with chest pain. Coronary angiography revealed complete obstruction of left coronary ostium with good collaterals from the right coronary artery. The coronary arterial tree was otherwise normal. Furthermore, aortagraphy showed a moderate degree of aortic regurgitation. From the examination of previous reports including our own case, we think that the angiographic features of syphilitic coronary ostial stenosis can be summarized as below. 1. Coronary artery stenosis is generally limited to the ostium. 2. The grade of stenosis almost always shows more than 90% stenosis, and sometimes bilateral coronary ostium can be affected. 3. Aortic regurgitation is frequently noted, associated with coronary ostial stenosis.

摘要

冠状动脉开口狭窄是一种罕见的病变,它是梅毒性主动脉炎、高安动脉炎、主动脉瓣疾病和家族性高胆固醇血症的并发症。我们报告一例因梅毒性主动脉炎导致的左冠状动脉开口梗阻病例。一名67岁男性因劳力性心绞痛10年病史入院。体格检查时,唯一的异常发现是2/6级高调舒张期杂音。生化检查未检测到冠状动脉危险因素,但梅毒螺旋体血凝试验(TPHA)和荧光螺旋体抗体吸收试验(FTA-ABS)均为阳性。平板运动试验显示与胸痛相关的ST段压低超过2mm。冠状动脉造影显示左冠状动脉开口完全梗阻,右冠状动脉有良好的侧支循环。冠状动脉树其他部分正常。此外,主动脉造影显示中度主动脉瓣反流。通过对包括我们自己病例在内的既往报告进行研究,我们认为梅毒性冠状动脉开口狭窄的血管造影特征可总结如下。1.冠状动脉狭窄一般局限于开口处。2.狭窄程度几乎总是显示超过90%的狭窄,有时双侧冠状动脉开口均可受累。3.常伴有主动脉瓣反流,与冠状动脉开口狭窄相关。

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