心タンポナーデで発症した冠動脈瘤を伴う冠動脈肺動脈瘻破裂の1例

Ruptured Aneurysm of the Coronary Arteriovenous Fistula Presented with Cardiac Tamponade

要旨　胸痛，心タンポナーデで発症した冠動脈瘤を伴った冠動脈肺動脈瘻破裂症例を経験した．精査の結果左右両冠動脈由来の冠動静脈瘻でそれぞれに冠動脈瘤を伴っていた．搬入時血圧低下を来したものの以後回復，循環動態は安定していたため待機的に手術を行った．体外循環駆動下心拍動下で右冠動静脈瘻/冠動脈瘤を処置，次いで心停止下に主肺動脈を離断して左前下行枝由来の冠動静脈瘻/冠動脈瘤を剥離摘出した．

　We report a case of ruptured coronary artery-pulmonary artery fistula with aneurysms, that presented with chest pain and cardiac tamponade. There were two coronary arteriovenous fistulae and aneurysms, which were from both coronary arteries. Apart from low blood pressure, the patient was relatively stable on arrival, so elective surgery was scheduled. Intraoperatively, right coronary arteriovenous fistula/aneurysm was ligated and divided under cardiopulmonary bypass while the heart was beating. Then the heartbeat was arrested and left coronary artery-pulmonary artery fistula/aneurysm was divided and excised, by means of transection of the main pulmonary artery.