Etoh T, Matsuda J, Hanada Y, Takenaga M, Ishikawa T, Koiwaya Y, Eto T
First Department of Internal Medicine, Miyazaki Medical College.
J Cardiol. 1997 Sep;30(3):143-7.
A 70-year-old man presented with repeated syncope induced by left ventricular outflow tract obstruction. He was referred to us because of repeated syncope with convulsion at rest. During syncope, electrocardiography showed marked ST segment depression with negative T waves in leads I, II, aVL, aVF and V2-V5 but no arrhythmias. Echocardiography revealed asymmetric septal hypertrophy and complete obstruction of the left ventricular outflow tract due to systolic anterior movement of anterior mitral leaflet and concomitant severe mitral regurgitation. During the catheterization study, syncope with convulsion developed repeatedly without antecedent cause, and was associated with a decrease in systemic blood pressure. Simultaneous pressure monitoring of the left ventricle and femoral artery showed a significant pressure gradient (maximum 110 mmHg). During each episode, systemic blood pressure rose spontaneously with the recovery of consciousness over several minutes. He received temporary atrioventricular sequential pacing and underwent successful mitral valve replacement. Four years later, he was doing well.
一名70岁男性因左心室流出道梗阻导致反复晕厥前来就诊。他因静息时反复出现晕厥伴抽搐而转诊至我院。晕厥期间，心电图显示I、II、aVL、aVF及V2-V5导联ST段明显压低，T波倒置，但无心律失常。超声心动图显示不对称性室间隔肥厚，由于二尖瓣前叶收缩期前向运动导致左心室流出道完全梗阻，并伴有严重二尖瓣反流。在导管检查过程中，反复出现无明显诱因的晕厥伴抽搐，且与体循环血压下降有关。左心室和股动脉同步压力监测显示存在显著压力阶差（最大110 mmHg）。每次发作期间，数分钟内随着意识恢复，体循环血压自发升高。他接受了临时房室顺序起搏，并成功进行了二尖瓣置换术。四年后，他情况良好。
