Japanese
Title周術期心筋梗塞をきたした左単冠状動脈症合併の弁置換術患者
Subtitle症例
Authors近藤泉*, 野村実*, 村田順子*, 吉田啓子*, 長沢千奈美*, 内田桂子*, 芦刈英理*, 白井希明*, 鈴木英弘*, 八田光弘**, 小柳仁**
Authors(kana)
Organization*東京女子医科大学麻酔科学教室, **東京女子医科大学日本心臓血圧研究所循環器外科
Journal循環制御
Volume15
Number3
Page456-459
Year/Month1994/
Article報告
Publisher日本循環制御医学会
Abstract「要旨」今回我々は単冠状動脈血を合併する49才男性に対する, 大動脈弁および僧房弁置換術の麻酔管理を経験した. 体外循環離脱時, 平均動脈圧57mmHg, 心係数2.1L/min/m2, 左室駆出率32%, 右室駆出率23%と心機能の低下が見られた. 術直後のICUにおける心電図は, II, III, aVFにST上昇がみられ, 24時間後クレアチニンキナーゼミオグロビン352mU/mlと上昇が認められ, 周術期心筋梗塞が疑われた. 単冠状動脈症は心筋梗塞を併発することが多く, 逆行性冠灌流等の心筋保護に対する工夫, 体外循環離脱時のカテコラミンや大動脈バルーンパンピングの積極的な使用を考慮すべきであった. 「はじめに」単冠状動脈症(SCA)を合併した大動脈弁閉鎖不全症および僧帽弁逸脱症の弁置換術後の体外循環離脱後に心機能低下を来たし, 周術期心筋梗塞が疑われた症例を経験した. 術中の心筋保護, 体外循環離脱後の冠血流維持の重要性について考察を加え報告する. 「症例」患者は49歳男性. 既往歴に痛風, 脳梗塞があった.
Practice基礎医学・関連科学
KeywordsSingle coronary artery, Perioperative myocardial infarction, Valve replacement.
English
TitlePerioperative Myocardial Infarction after Aortic and Mitral Valve Replacement with a Single Coronary Artery Disease
Subtitle
AuthorsIzumi Kondo*, Minoru Nomura*, Junko Murata*, Keiko Yoshida*, Tinami Nagasawa*, Keiko Utida*, Eri Asikari*, Kimei Sirai*, Hidehiro Suzuki*, Mituhiro Hatida**, Hitoshi Koyanagi**
Authors(kana)
Organization*Department of Anesthesiology, The Heart Institute of Japan, Tokyo Women's Medical College, **Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical College
JournalCirculation Control
Volume15
Number3
Page456-459
Year/Month1994/
ArticleReport
PublisherJapan Society of Circulation Control
AbstractA single coronary artery disease (SCA) is a rare congenital anomaly. The patients with this disease are often suffered from angina pectoris or myocardial infarction due to underdeveloped blood supply by a small or hypoplastic vessel. We reported a case in which a 49-yr-old man with SCA disease (Lipton L1 type) underwent mitral and aortic valve replacement. After weaning from cardiopulmonary bypass (CPB), Mean Artery Pressure (MAP), Cardiac Index (Cl) and Left ventricular ejection fraction (LVEF) decreased 57mmHg, 2.1L/min/m2 and 32% compared with control values 92mmHg, 3.1L/min/m2 and 57% but right ventricular ejection fraction (RVEF) did not change and slightly the regional wall motion abnormalities were observed in transoesophageal echocardiography. The confirmation of a perioperative myocardial infarction (PMl) was documented by postoperative 12-lead ECG (the ST elevation in leads II, III, aVF) and the elevation of Creatine Kinase Myocardial Band 352mU/mL. In care with SCA, the myocardial protection during aortic-cross clamping is one of the most important factor of prevention of PMl, and we should keep the coronary blood flow using appropriate doses of cathecolamine of Intra Aortic Balloon Pumping after cardiopulmonary bypass.
PracticeBasic medicine
KeywordsSingle coronary artery, Perioperative myocardial infarction, Valve replacement.

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