Kouichi Hasegawa

Left recurrent laryngeal nerve palsy associated with primary pulmonary hypertension and patent ductus arteriosus

Two patients with left recurrent laryngeal nerve paralysis in association with pulmonary artery hypertension are described. One had primary pulmonary hypertension and the other had patent ductus arteriosus. The greatly dilated pulmonary artery in these patients resulted in compression of the left recurrent laryngeal nerve and produced a cardiovocal (Ortners) syndrome. The pathogenesis of the vocal cord palsy was documented by cross-sectional computed tomography. In conclusion, computed tomography is of great help in differentiating this syndrome from other diseases such as mediastinal mass or lymphadenopathy whenever hoarseness is complicated by pulmonary hypertension.

運動負荷後の回復期に収縮期血圧が再上昇する“異常血圧反応”例に関する検討-冠動脈疾患例について

概 要 冠動 脈疾 患 を疑 ってtreadmill(T)負 荷試 験 を行 なった症例 の うち,回 復期 の収縮 期血 圧 が 終了時 よ りも15mmHg以 上上 昇 した35例 につ いて検討 した.24例 は器質 的冠狭 窄(≧75%) を認 め多枝病 変 例が 多か ったが,11例 は正常冠動 脈例 であ った.両 群 と も負 荷中 の血 圧上 昇度 が低 く(19±14mmHg,18±20mmHg),終 了時 におけ るST下 降(-0 .14±0.10mV,-0.18± 0.08mV), P-TFの 著 明 な増 大(4.3±33msec・mV,3.0±1.8msec・mV)を 示 す例 が多 かった. 前 者 は後者 に比 して,T時 間 が短 く,回 復 期の血圧 再上昇 の程度 が著 し く,持 続 時間 の長 い例 が 多か った.回 復 期の血圧 再 上昇 には,重 症 冠動脈 疾患等 にお け る負荷 中の強 い心筋虚 血 に よる 左 心機能 の抑 制 や,最 大運動 負荷 の影響 が考 え られ た.〔日 内会 誌 77:1383~1387, 1988〕

Right ventricular outflow obstruction secondary to post-infarction aneurysm: A possible new syndrome

SummaryTwo patients with extensive anterior myocardial infarction developed a hitherto unreported type of right ventricular outflow tract obstruction. A 71-year-old woman, who had had an acute infarction 10 years before, was admitted for sustained ventricular tachycardia. A loud ejection murmur was heard in the mid-precordium. The echocardiogram and left ventriculogram showed a septal aneurysm, with a systolic gradient of 21 mmHg between the right ventricular outflow tract and apex. The ejection murmur was detected in the outflow tract by intracardiac phonocardiography. The second patient was a 60-year-old man who had had an acute infarction at age 47. He was also referred because of ventricular tachycardia, and his clinical situation was almost the same as that of the first case. Our search of the literature failed to disclose any similar case with a loud ejection murmur confirmed by intracardiac phonocardiography to be due to an obstructive septal aneurysm.