A Critical Increase in Right-to-Left Shunt After Acute Myocardial Infarction in a 68-year-old Male With Tetralogy of Fallot
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概要
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A male patient with tetralogy of Fallot accompanied by aortic regurgitation had maintained sufficient exercise capacity for a number of decades with the status of acyanotic tetralogy of Fallot. When he was 67 years old, he suffered a posterior wall acute myocardial infarction and direct percutaneous coronary angioplasty successfully revascularised the target lesion in the left circumflex artery. However, a few months after the onset of the myocardial infarction, his shortness of breath became clinically significant and was associated with increased right-to-left shunt and increased right ventricular end-diastolic pressure, as well as hypoxia. At 68 years old, therefore, total corrective repair of the tetralogy with replacement of the aortic and pulmonary valves was performed. The patient was asymptomatic after the successful operation. This report suggests that coronary artery disease can be one of the potential factors in inducing critical hemodynamic changes in aging patients with congenital heart disease, especially those who have a shunt between the right and left chambers. The unique clinical course is described with some discussion of the repair of tetralogy in adults. <br>
著者
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Kubo Keishi
First Department Of Internal Medicine Dhinshu University School Of Medicine
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Sekiguchi Morie
Akasaka Sekiguchi Clinic International
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Izawa Atsushi
First Department Of Internal Medicine Shinshu University School Of Medicine
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Amano Jun
Division Of Cardiovascular Surgery Shinshu University
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Owa Mafumi
First Department Of Internal Medicine Shinshu University School Of Medicine
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Uchikawa Shin-ichiro
First Department Of Internal Medicine Shinshu University School Of Medicine
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Yazaki Yoshikazu
First Department Of Internal Medicine Shinshu University School Of Medicine
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Kinoshita Osamu
First Department Of Internal Medicine Shinshu University School Of Medicine
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Imamura Hiroshi
Department Of Chemistry Faculty Of Science Kyushu University:(present Office)new Drug Research &
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Yazaki Yoshikazu
First Department of Internal Medicine, Division of Cardiovascular Medicine, Shinshu University School of Medicine
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Owa Mafumi
First Department of Internal Medicine, Division of Cardiovascular Medicine, Shinshu University School of Medicine
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Kubo Keishi
First Department of Internal Medicine, Division of Cardiovascular Medicine, Shinshu University School of Medicine
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Ikeda Uichi
First Department of Internal Medicine, Division of Cardiovascular Medicine, Shinshu University School of Medicine
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Kitahara Hiroto
Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine
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Uchikawa Shin-ichiro
First Department of Internal Medicine, Division of Cardiovascular Medicine, Shinshu University School of Medicine
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Sekimura Noriyuki
First Department of Internal Medicine, Division of Cardiovascular Medicine, Shinshu University School of Medicine
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