頭痛と胸痛で発症し，下壁誘導に明瞭なJ波を伴ったBrugada症候群の1剖検例

症例は27歳の男性．睡眠中の頭痛と胸痛を訴えて救急外来を受診した．失神症状はなく，不整脈の既往や突然死の家族歴もなかった．12誘導心電図検査で右側胸部誘導にcovedタイプのST上昇（type 1 ECG）と，下壁誘導（II，III，aVF）に明瞭なJ波を認めたが，器質的心疾患は否定的であった．1ヵ月後に心静止を生じ，蘇生処置に反応なく死亡した．病理解剖では，両心室の厚さの不均一性，軽度の心筋肥大，左室前壁と下壁，右室心尖部および右室流出路周囲の心外膜側に脂肪変性を認め，血管周囲を架橋するような心筋束が確認された．また，右室流出路に近い心外膜に多核白血球を含む炎症細胞浸潤が見られ，これらの所見はBrugada症候群の病理組織像として矛盾しないものと考えた．

We report the case of a 27-year-old male who had visited our hospital complaining of headache and chest pain during sleep. He had neither a family history of sudden cardiac death nor a past history of syncope and arrhythmias. Twelve-lead ECG showed coved-type ST-segment elevation in the right precordial leads and prominent J wave in the inferior leads. Laboratory tests and echocardiography were normal. He made an emergency visit one month later, presenting cardiac standstill. He died without response to cardiopulmonary resuscitation. Autopsy revealed no gross abnormality. A more detailed pathological evaluation led to some characteristic findings. Bilateral ventricular wall showed irregular thickness with mild myocardial hypertrophy. An epicardial fibrofatty degeneration and myocardial bundle around the vasculature were observed in the left anterior and posterior wall, right wall of the apex, and right ventricular outflow tract. In addition, focal inflammation with multinuclear leukocytes was seen in the epicardium by the right ventricular outflow tract. These findings are consistent with previous autopsy reports for patients with Brugada syndrome.