Nishimura N, Bando S, Yamamoto H, Nishikado A, Akiyama K, Mori H
Kokyu To Junkan. 1989 Jan;37(1):97-100.
A 51-year old man was admitted to our hospital, because of syncope. During admission, he had three episodes of syncopal attack. During the episodes, monitor ECG showed two times of ventricular tachycardia and one of paroxysmal A-V block. The left ventriculogram showed dilatation of left ventricle with posterobasal aneurysm, anterobasal and apical hypokinesis. The left coronary artery was normal. The right coronary artery originated from the left sinus of Valsalva and passed through between aortic root and pulmonary trunks. There was no atherosclerotic lesions in both coronary arteries. Non-sustained ventricular tachycardia was induced by triple premature stimulations. The inverse relation between the coupling interval of premature stimulation and the echo interval was recognized. Lidocaine (50 mg IV), Flecainide (300 mg/day), Mexiletine (450 mg/day), and Aprindine (60 mg/day) prevented ventricular tachycardia. Rapid atrial pacing induced paroxysmal A-V block. Permanent pacemaker was implanted because of syncope due to paroxysmal A-V block and ventricular tachycardia was prevented by Aprindine. Recently, the case with anomalous origin of the coronary artery increased by the popularity of coronary angiography. But, this case considered to be rare because of complication with ventricular aneurysm and lethal arrhythmia (ventricular tachycardia and paroxysmal A-V block).
一名51岁男性因晕厥入院。住院期间，他发生了3次晕厥发作。发作期间，监测心电图显示2次室性心动过速和1次阵发性房室传导阻滞。左心室造影显示左心室扩张，伴有后基底动脉瘤形成，前基底和心尖运动减弱。左冠状动脉正常。右冠状动脉起源于左冠窦，走行于主动脉根部与肺动脉干之间。两支冠状动脉均无动脉粥样硬化病变。三联律早搏刺激可诱发非持续性室性心动过速。发现早搏刺激的联律间期与回波间期呈反比关系。利多卡因（静脉注射50mg）、氟卡尼（300mg/天）、美西律（450mg/天）和茚满丙二胺（60mg/天）可预防室性心动过速。快速心房起搏可诱发阵发性房室传导阻滞。由于阵发性房室传导阻滞导致晕厥，植入了永久性起搏器，茚满丙二胺预防了室性心动过速。近年来，随着冠状动脉造影的普及，冠状动脉起源异常的病例有所增加。但该病例因合并心室动脉瘤和致命性心律失常（室性心动过速和阵发性房室传导阻滞）而被认为较为罕见。
