動脈瘤化した冠動脈肺動脈瘻の1手術治験例

A case report of aneurysmal coronary arterio-venous fistula

　従来，冠動静脈瘻は比較的まれな疾患と考えられてきたが，近年冠動脈造影の普及に伴い冠動静脈瘻の診断が容易となり，報告例も増加している。

　著者らは，両側の冠動静脈瘻で，左冠動脈瘻は前下行枝のSeg．6から分枝しており，しかも、瘻の動脈瘤化を認めた症例を経験したので，若干の文献的考察を加え，手術治験例を報告する。

The patient was a 53 year-old woman who suf-fered from palpitation and chest discomfort. Coro-nary arteriography showed the bilateral coronary arterio-pulmonary artery fistula with saccular aneu-rysm, especially in left coronary artery.

The operative indication was as follows:

(1) clinical and subjective complains (palpitation, chest discomfort)

(2) large shunt left side to right (66.1%)

(3) ischemic change in electrocardiography

(4) high risk of saccular aneurysm being rup- tured.

The operation for coronary artery fistula was un-dertaken under the cardiopulmonary bypass. The left coronary artery fistula derived from left anterior descending artery (seg. 6) and drained to pulmonary artery, and more accompanied with the saccularaneurysm.

Left coronary artery fistula was ligated in the proximal portion of fistula neighboring seg. 6 an-terior descending artery, and simultaneously, intra-pulmonary ligation was performed in the distal por-tion of coronary fistula.

Postoperatively the patient was in good condition, free from palpitation and chest discomfort. Coro-nary arteriography showed that coronary arterio-pulmonary fistula was completely disappeared in both coronary artery.