| Japanese |
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| Title | 術前に経皮的冠動脈形成術を施行し重篤な経過をたどった1例 |
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| Subtitle | 症例 |
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| Authors | 角田博, 中村久美, 紀敦成, 若松拓彦, 北村里恵 |
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| Authors(kana) | |
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| Organization | 京都市立病院麻酔科 |
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| Journal | 循環制御 |
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| Volume | 25 |
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| Number | 3 |
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| Page | 285-288 |
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| Year/Month | 2004/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 「緒言」冠動脈疾患患者, 特に粥腫由来の血栓など冠動脈の器質的狭窄を有する患者では, 手術侵襲による心筋の酸素需要増加に応じて心筋への酸素供給を増加させることができないため, 周術期に心筋虚血を生じやすいと考えられている. このため, 耐術性を高める目的で, 非心臓手術前に経皮的冠動脈再建術(PTCA)を施行されることが少なくない. しかし, 術前のPTCAが周術期の合併症を減少させることのevidenceとなり得る比較対照試験はない. このため, ACC/AHAのガイドライン1)では, 非心臓手術の術前の冠動脈造影および耐術性を高める目的でのPTCAの適応は限定されている. 我々は, 経尿道的手術の術前に, 麻酔科医と循環器内科医との議論がないまま循環器内科医が施行したPTCAで, 結果的に心筋梗塞を来たし, 経尿道的手術を施行できなかった1症例を経験した. 「症例」83歳の女性(身長153cm, 体重53kg). 50歳時より糖尿病を指摘され, 75歳時よりインシュリン自己注射を行っていた. 62歳時に急性心筋梗塞(回旋枝病変), 68歳時に洞不全症候群を来たした. 73歳時に歩行時の狭心症発作がみられ, 冠動脈造影で, #6 75%, #7 75%, #11 100%の狭窄が認められた. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | transurethral surgery, coronary artery disease, percutaneous coronary intervention, complication, acute myocardial infarction |
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| English |
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| Title | Transurethral Surgery and Preoperative Coronary Intervention：A Case Report |
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| Authors | Hiroshi SUMIDA, Kumi NAKAMURA, Atsunari KINO, Takuhiko WAKAMATSU, Rie KITAMURA |
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| Authors(kana) | |
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| Organization | Department of Anesthesia, Kyoto City Hospital |
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| Journal | Circulation Control |
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| Volume | 25 |
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| Number | 3 |
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| Page | 285-288 |
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| Year/Month | 2004/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | Preoperative application of coronary angiography or percutaneous coronary intervention(PCI)is controversial in Japan. We report a case in which PCI, performed before minor surgery, led to acute myocardial infarction. An 83-year-old woman was scheduled for transurethral resection of a bladder tumor under spinal anesthesia. Her condition was complicated by type 1 diabetes mellitus, and she had a history of myocardial infarctions 21 years and 9 years previously. The ischemic symptoms had not exhibited since the last myocardial infarction under suitable medical treatment. Preoperative coronary angiography was performed, and revealed threevessel disease. One month later, PCI was performed, but acute myocardial infarction occurred during the procedure, followed by cardiac collapse. The patient was resuscitated without neurological consequences, but was hospitalized for another 187 days. The planned surgery was canceled. This case lets us consider the adoption of ACC/ACH guidelines, in which PCI is not recommended before minor surgery on patients lacking major clinical predictors of increased cardiovascular risk. Otherwise, we have to establish another set of guidelines based on evidence applicable to the Japanese population. |
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| Practice | Basic medicine |
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| Keywords | transurethral surgery, coronary artery disease, percutaneous coronary intervention, complication, acute myocardial infarction |
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