| Japanese |
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| Title | PCI後に発症した冠動脈仮性瘤に対するOn-lay patch冠動脈バイパス術の1例 |
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| Subtitle | 症例 |
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| Authors | 合志桂太郎, 土井潔, 大川和成, 夜久均 |
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| Organization | 京都府立医科大学大学院医学研究科心臓血管・呼吸器外科学 |
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| Journal | 循環制御 |
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| Volume | 29 |
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| Number | 2 |
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| Page | 167-172 |
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| Year/Month | 2008/9 |
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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」経皮的冠動脈形成術(PCI)後の合併症として, 冠動脈仮性瘤の報告は稀である1〜3). その治療として, 破裂および血栓閉塞の危険性から, 外科的修復が要求されることが多い3,4). 今回我々はPCI後に発症したと考えられる冠動脈仮性瘤に対し, On-lay patch冠動脈バイパス術(CABG)を施行し良好な結果を得たので報告する. 「症例」42歳の男性が突然の胸痛を自覚し, 近医を受診したところ, 心電図と血液検査から急性心筋梗塞と診断された. 緊急冠動脈造影の結果, 左前下行枝(＃7)の閉塞を認めたため, POBA(Primaly Old Balloon Angioplasty)が施行された. 2週間後のfollow up冠動脈造影(CAG)で再狭窄を認めず退院となった. 3ヵ月後のfollow up CAGでPOBA施行部位に90%の狭窄を認め, 更に直径約8mmの嚢状冠動脈瘤も認めたため, 当科に外科的治療目的に紹介入院となった. 入院時の身長175cm, 体重82.5kgで, 血圧は120/70mmHg, 脈拍は70/minで整, 心音と呼吸音は共に清であった. 胸部レントゲン写真では心胸郭比が42%であった. 心電図所見では洞調律でV1〜4はQSパターンを示していた. 血液検査所見に特に異常は認めなかった. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | coronary aneurysm, surgical treatment, on-lay patch, CABG, PCI |
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| English |
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| Title | On-Lay Patch Coronary Artery Bypass Grafting for a PseudoAneurysm after Percutaneous Coronary Intervention |
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| Authors | Keitaro Koushi, Kiyoshi Doi, Kazunari Okawa, Hitoshi Yaku |
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| Organization | Department of Cardiovascular and Thoracic Surgery, Kyoto Prefectural University of Medicine |
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| Journal | Circulation Control |
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| Volume | 29 |
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| Number | 2 |
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| Page | 167-172 |
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| Year/Month | 2008/9 |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | A 42year-old man was referred to our hospital due to a coronary artery aneurysm(8mm in diameter)after percutaneous coronary intervention. He had a history of acute myocardial infarction in the left anterior descending artery(LAD)and balloon angioplasty three months previously. Coronary artery bypass grafting(CABG)was performed using cardiopulmonary bypass and cardioplegia. At the operation, a pseudoaneurysm was found between 1st and 2nd septal branch. A longitudinal incision of 40mm length was made on the LAD across the aneurysm and stenosis. The left internal thoracic artery(LITA)was anastomosed with 8-0 prolene sutures(on-lay patch). The 3 dimension computed tomography before discharge showed disappearance of the aneurysm and good patency of the LITA graft to the LAD. Although PCIrelated coronary artery aneurysm was relatively rare. Once it is found, surgical treatment was recommended due to the threat of rupture. Although plication or ligation of the coronary aneurysm and distal coronary bypass have been recommended, onlay patch CABG may be useful and can be an option to avoid sacrifice of the major branches near by the aneurysm. |
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| Practice | Basic medicine |
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| Keywords | coronary aneurysm, surgical treatment, on-lay patch, CABG, PCI |
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