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���������� �� IRBBB ��������������� �������� ��� IRBBB��� V1�V2� R������� V1�2 � R��!�"#$ VPC %&'(���)*�+,-�"./ VPC 0�+12��3��%� 4�5������')*��6��7���8������9���� ���":;<� X=>?"#$@ABC�DE0&'�F��������: GH� �I0 II� III�J�KE�LIJ�F��� MN�O0P�QR���S�TU!VWBC0&'�F������:�� ���XYZ 12�[� �V1�[� rSR�6 �IRBBB�, V1�2 � R� "#$

V5�V6 �[�\. S��&'� �Fig. 1��� ���XYZ 12�[� �IRBBB, V1�2� R����]��BC�&'�%� ^��_�� VPC �&'�� `�a��+,-%"b�c�� VPC 0�+12��3��%� 3�2����� �Fig. 2��� de�":;XYZ 12�[� �

��]�� IRBBB, V1�2 � R� "#$VPC �&'�� fghi�jk,-�0 VPC 0�+12�lm�� 3�2�������� ���:�� �noi�p�Bqir ��stuvw��tx�y#z{s|}~���1� 20�25 mm������noi�%&'(�� �Fig. 3�� ~���tu�0����� ���Dw)*�&'�� ��ir���i �/�������&'�%� 8��tu��{s�����!;��0&'�F���� 99mTc �v��������������������&'� �v�����%����� �Fig. 4��

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Fig. 1 Standard 12-lead electrocardiogram at the first check-up.

The rSR� pattern and poor R progression were observed in lead of V1�2.

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Fig. 2 Standard 12-lead electrocardiogram �left� and selective three leads electrocardiogram withexercise test �right� at the second check-up.Black dots suggest VPC. VPCs increase in 3 minutes after exercise.

Fig. 3 Echocardiogram �B-mode method�.A cystic lesion with a thin surface and a diameter of about 20 mm was visual-

ized in the center of the interventricular septum �see arrow�.

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Fig. 5 System of annual check-up of electrocardiogram in school

children in Kawasaki city

Fig. 4 Myocardial scintigram �99mTc-tetrofosmin�Perfusion defect at the septal area of the short axial view �see arrow�.

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2� Chesler E, Tucker RBR, Barlow JB. Subvalvu-lar and apical left ventricular aneurysms in the

Bantu As a source of systemic emboli. Circula-

tion 1967; 35: 1156�1162.3� Hamaoka K, Onaka M, Tanaka T. Congenitalventricular aneurysm and diverticulum in chil-

dren. Pediatr Cardiol 1987; 8: 169�175.4� Paronatto F, Strauss L. Aneurysm of the leftventricle due to congenital muscle defect in an

infant. Report of a case with discussion of

pathogenesis of associated endocardial fibro-

elastosis. Am J Cardiol 1963; 12: 721�729.5� Grossi E, Colvin S, Galloway A, RutkowskiM. Repair of posterior left ventricular aneu-

rysm in six-year-old boy. Ann Thorac Surg

1991; 51: 484�487.6� KL¸¹� -zº� �»¼{� V1, V2+,�QS PQRS9GH�-U�������"�

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Abstract

A Case with Cardiac Ventricular Aneurysm at Interventricular

Septum Detected in The Annual Clinical Check-up

for School Children in Kawasaki City

Kohtaro Murano, Yoshimitsu Tsuzuki, Masaki Arima, Kenjiro Goto,

Kentaro Aso, Yachiyo Kurihara, and Yasushi Koitabashi

Ventricular aneurysm is rarely found in children. The aneurysm of the muscular interventricular septum

is very rare. We experienced a case of 6 years old girl with ventricular aneurysm of the muscular

interventricular septum detected at the annual clinical check-up of heart disease for school children in

Kawasaki city.

An incomplete right bundle branch block �IRBBB� was detected by ECG examination at the firstcheck-up. At the second check-up, the chest X-ray and auscultation were normal. At the ECG examination

of the second check-up, IRBBB was found again and a low voltage of the R wave in leads of V1, V2 and the

ventricular premature contraction �VPC� was pointed out.These VPCs were diagnosed as the exercise induced type by the exercise test. She was introduced to our

hospital and echocardiogram was performed. In this study, a cystic aneurismal lesion, approximately 20 mm

in diameter, was visualized in the center of the muscular interventricular seputum. On myocardial scan, there

was no perfusion in the prominent area of the aneurysm. We diagnosed this case as a congenital aneurysm

of the muscular interventricular septum.

We reported a rare case of the congenital aneurysm of the muscular interventricular septum, which was

diagnosed by the abnormal ECG findings at the clinical check-up for school children.

Keywords

clinical check-up for school children, incomplete right bundle branch block,

ventricular arrhythmias, aneurysm of the interventricular septum

Department of Pediatrics, St. Marianna University School of Medicine

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