冠動脈内血栓溶解術が不成功に終わった冠動脈塞栓と思われる一例

Unsuccessful percutaneous transluminal coronary recanalization in coronary embonism

　1981年Rentropら^1）およびGanzら^2）によって報告されたpercutaneous transluminal Coronary recanaliza—tion （PTCR）は，広く日本でも普及してきており，その望ましい結果が諸家より発表されている^3〜8）。しかし，冠動脈塞栓によると考えられる心筋梗塞にPTCRを行ったという報告はまだ考えられない。今回我々は，僧帽弁狭窄兼大動脈弁閉鎖不全症で心房細動を有していた43歳の男性で，冠動脈塞栓が原因と考えられる急性下壁心筋梗塞に，発症後3時間という急性期にPTCRを試入興味深い知見を得たので報告する。

A 43 year-old man with mitral stenosis and aortic regurgitation was admitted to our hospital because of progressive anterior chest pain. The electro-cardiogram showed atrial fibrillation and ST-segment elevation in leads II, III, and aVF. Coronary arteriography and percutaneous translumi-nal coronary recanalization (PTCR) were performed 3 hours after the onset of his symptoms. The right coronary artery showed complete obstruction just distral to the acute marginal branch without atheromatous change. Inspite of 500pg nitro-glycerin infusion and urokinase infusion into the right coronary artery at a rate of 24000U/min for 50 minutes, combining with "pocking" technique, recanalization could not be obtained. The restudy 6 weeks after PTCR, revealed complete recanaliza-tion of the right coronary artery, but no significant improvement of left ventricular contraction. These findings strongly suggest that the cause of the coronary occlusion in this case was due to coronary embolism. Much higher dose of urokinase would be required in this case.