무심잡음성 대동맥판폐쇄부전증

Abstract

[한글]

1974년 Segal등이 무심잡음성 대동맥판 폐쇄부전증에 대하여 보고한 후 이것이 특히 다른 심장판막증과 병발되어 있는 경우 심장판막증의 치료 및 그 예후에 지대한 영향을 줄 수 있다는 사실이 알려졌지만, 국내에서는 아직도 이에 대한 보고가 없는 실정이다.

저자는 대동맥 조영술로 확인된 95예의 동맥판폐쇄부전증 환자중 특징적인 조기점감성확장기잡음(early decrescendo diastolic murmur)을 청진할 수 없었던 17예를 고찰하였다.

17예의 대상환자중 승모판협착증만을 동반하였던 환자는 12예, 승모판협착 및 폐쇄부전증을 동반하였던 환자는 4예, 승모판폐쇄부전증을 동반하였던 환자는 1예이었고, 대동맥조영술상 역류정도는 gradeⅠ이 7예, gradeⅡ는 10예이었으나, gradeⅢ와 Ⅳ는 없었다.

무심잡음성 대동맥판폐쇄부전증(silent Aortic Regurgitation)의 병발여부는 흉통, 말초맥박 및 심첨부박동, 맥압확장, 흉부 X-선 및 심전도상의 좌심실비대 소견등으로 추측할 수도 있겠으나 대동맥조영술에 의해서만 확진이 가능하였다.

[영문]

Aortic regurgitation is a commom valvular heart disease, usually the result of rheumatic fever, or syphilis, and rarely of congenital origin. It is frequently associated with other valvular heart diseases, especially mitral valve disease. It can be diagnosed by the presence of pulse pressure widening, a Corrigan pulse, and an early decrescendo diastolic murmur at the left sternal border between the second and third intercostal spaces. After the clinical application of cineaortography in the diagnosis of valvular heart disease, Segal et al(1964) first reported rheumatic aortic regurgitation without an audible murmur in patients having mitral valve disease. The importance of discovering aortic regurgitation in patients with predominant mitral disease has begun to be appreciated recently, especially as commissurotomies for the relief of mitral stenosis are performed more frequently. Nowadys even though the severity of aortic regurgitation is often not evident preoperatively, aortic regurgitation can become very evident when mitral stenosis is relieved.

This study was comprised of seventeen patients with silent aortic regurgitation which was confirmed by cineaortgraphy at Severance Hospital from January, 1970 to August, 1976.

1. Of the seventeen patients, 12 patients were associated with mitral stenosis, 4 with mitral steno-insufficiency, and 1 with mitral insufficiency.

2. Silent aortic regurgitation was suggested from the accompanying clinical features such as chest pain, apical pulse bounding, pulse pressure widening, and a left ventricular hypertrophy pattern on both roentgenogram of the chest and electrocardiogram.

3. The severity of the aortic regurgitation was mild to moderate; 7 of the 17 patients being grade Ⅰ and 10 patients being grade Ⅱ with no grade Ⅲ and Ⅳ regurgitation noted on cineaortogram.