急性発症の治療抵抗性心不全を呈した高齢者閉塞性肥大型心筋症の一例

A case of hypertrophic obstructive cardiomyopathy in the elderly

presenting as refractory congestive heart failure of acute onset

泉知里，伊賀幹二，近藤博和，田村俊寛， 猪子森明， 北口勝司，

日村好宏，玄　博允，小西　孝

Summary

An 84-year-old female was admitted to our hospital due to left heart failure of

acute onset. Transthoracic echocardiography showed diffuse hypertrophy of the normalized hyperkinetic left ventricle and chordae-like fluttering echo was attached on the mitral valve with severe mitral regurgitation signal. Although mosaic flow signal was seen at left ventricular outflow tract, the velocity could not be measured. Obvious mitral valve prolapse was not seen by emergent transesophageal echocardiography. Cardiac catheterization showed more than 100mmHg pressure gradient between the left ventricle and the femoral artery. Pressures of the femoral artery and the pulmonary capillary wedge changed reciprocally at intensive care unit; a bisferient narrow pulse pressure of the femoral artery was associated with increased v wave of pulmonary capillary wedge pressure, while a wide pulse pressure of the femoral artery with disappearance of v wave of pulmonary capillary wedge pressure. Pressure monitoring at intensive care unit and transesophageal echocardiography were useful to understand the pathophysiology of the patient.