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Kokyu to Junkan Volume 37, Issue 9 （September 1989）

呼吸と循環 37巻9号（1989年9月発行）

Japanese English

症例

中年になって胸痛発作で発症した先天性冠動脈肺動脈瘻の冠循環動態について Coronary hemodynamics in a patient developing chest pain in the middle age owing to congenital coronary-pulmonary fistula 三国谷淳 ¹ , 木村俊昭 ¹ , 菊池文孝 ¹ , 戸塚英徳 ¹ , 田村太志 ¹ , 小野寺庚午 ¹ , 小山浩一 ² , 鯉江久昭 ² , 大池弥三郎 ³ Atsushi Mikuniya ¹ , Toshiaki Kimura ¹ , Fumitaka Kikuchi ¹ , Hidenori Totsuka ¹ , Futoshi Tamura ¹ , Kogo Onodera ¹ , Kouichi Koyama ² , Hisaaki Koie ² , Yasaburo Oike ³ ¹弘前大学医学部第二内科 ²弘前大学医学部第一外科 ³黎明郷リハビリテーション病院 ¹The Second Department of Internal Medicine, Hirosaki University School of Medicine ²The First Department of Surgery, Hirosaki University School of Medicine ³Reimeikyo Rehabilitation Hospital pp.1015-1020

発行日 1989年9月15日 Published Date 1989/9/15

DOI https://doi.org/10.11477/mf.1404205549

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Abstract 文献概要
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　比較的稀な疾患とされてきた先天性冠動脈肺動脈瘻^1）も，冠動脈造影手技の普及に伴いその報告は増加している^2,3）。しかし，本疾患にみられる胸痛についてはcor-onary steal^4）で説明されているが，十分な検討がなされているとはいい難い。今回われわれは，中年になって前胸部痛で発症した先天性冠動脈肺動脈瘻症例の冠血流量を瘻閉鎖前後で測定し，本疾患にみられる胸痛出現の機序について若干の検討をしたので報告する。

Recently reports of congenital coronary-pulmonary fistula have been increasing with the wide-spread use of coronary angiography. However, the cause of the angina sometimes seen as a chief complaint in coronary fistula has not been well demonstrated although it has been suggested that coronary steal phenomenon accounts for it. This report docu-mented coronary hemodynamics in a patient who came to develop anterior chest pain in the middle age owing to congenital coronary-pulmonary fistula, measuring coronary flow before and after the fistula-closure operation.

A 35-year-old woman suffered from a sudden onset of severe anterior chest pain in April, 1986. Shewas referred to our hospital on suspicion of ruptured aneurysm of Valsalva. Ausculatation disclosed con-tinuous murmur at 3 LSB, but no evidence of rup-tured aneurysm of Valsalva was detected by echo-cardiography nor aortography. Coronary angiogra-phy showed both left and right coronary fistula into the stem of pulmonary artery and otherwis normal angiogram. Great cardiac vein flow (GCVF) measu-red with regional thermodilution method was 25 ml/min at rest (70 bpm) and 30 mlimin during rapid atrial pacing (150 bpm) before the operation, and 30 m//min (78 bpm) and 58 ml/min (150 bpm) after the operation, respectively. Before the surgery, anterior coronary resistance (CRant) was higher than that in normal subjects at rest and remained almost steady during atrial pacing. After the surgery, CRant was still higher at rest but remarkably reduced during pacing of 150 bpm.

These findings suggest that the gradual increase in peripheral coronary resistance for a long time may lead to the inducement of coronary steal in the middle-later age in patients with coronary fistula.