第4巻 2008年2月　第1号

■症例報告

動脈管開存を有し，分娩後に大動脈解離を来した1例
山本　良也¹, 市丸　愛¹, 岡本　麻美¹, 中川　誉之¹, 鈴木　大悟², 中田　淳³, 加藤　浩司³, 田中　啓治³, 竹下　俊行^4
1日本医科大学第6学年
²日本医科大学付属病院研修医
³日本医科大学付属病院集中治療室
⁴日本医科大学大学院医学研究科女性生殖発達病態学

A Case of Acute Aortic Dissection with Patent Ductus Arteriosus after the Labor
Yoshiya Yamamoto¹, Ai Ichimaru¹, Asami Okamoto¹, Takayuki Nakagawa¹, Daigo Suzuki², Jun Nakata³, Koji Katoh³, Keiji Tanaka³ and Toshiyuki Takeshita^4
1Sixth-year Medical Student, Nippon Medical School
²Resident, Nippon Medical School
³Division of Intensive and Coronary Care Unit, Nippon Medical School Hospital
⁴Department of Female Reproductive and Developmental Medicine, Graduate School of Medicine, Nippon Medical School

Case: A 33-year-old female.
Present history: She delivered a child of 40 weeks' gestational age following an uncomplicated pregnancy and labor. Four days later, she complained of severe epigastralgia, back pain, and pain in the left lower extremity. She was immediately transferred to our Critical Care Unit on suspicion of aortic dissection.
Clinical course: On admission, her blood pressure was 202/94 mmHg (left arm), and her ankle-brachial index was 0.74 (right) and 0.81 (left). Emergency computed tomography examination revealed that the dissection extended from the descending aorta to both common iliac arteries (Stanford B, DeBakey IIIb). In addition, patent ductus arteriosus (PDA) starting at the true lumen of the descending aorta was observed. We started antihypertensive therapy with nicardipine, which gradually controlled her blood pressure and alleviated the ischemia of both lower extremities.
Discussion: Most patients with aortic dissection during pregnancy also have Marfan's syndrome, but no pathognomonic findings indicating this syndrome were present in this case. The possibility of a muscle myosin heavy chain genetic mutation was suggested as the reason for the PDA complication in our patient. We need to be aware of the danger of acute aortic dissection during pregnancy or delivery not only in patients with Marfan's syndrome but also in patients with PDA.

日医大医会誌 2008; 4(1), 45-49

Key words
acute aortic dissection, labor, pregnancy, patent ductus arteriosus

Correspondence to
Yoshiya Yamamoto, Sixth-year Medical Student, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
E-mail：s02-093yy@nms.ac.jp

受付：2007年10月10日　受理：2007年12月3日