狭心症を伴った冠動脈瘻の1例

A case of coronary artery fistula with angina pectoris

　先天性冠動脈瘻は，比較的まれな疾患であるとされてきたが，近年の選択的冠動脈造影の発達とともに，その報告例も増加している。しかし，本症に狭心症，心筋梗塞などの冠不全症状を呈する症例は比較的少ない。我我は，労作時に狭心痛を訴える患者に冠動脈造影を施行し，左右冠動脈・肺動脈瘻の認められた1例を経験した。この例は，右冠動脈瘻より末梢の動脈硬化病変のため，その領域の心筋虚血とcoronary stealをきたしたと考えられる。本稿では，この症例について若干の文献的考察を加えて報告する。

A case of coronary artery fistula with myocardial ischemia is reported. A 57-year-old-man was admitted to our hospital complaining of anterior chest pain on exertion. Submaximal Treadmill exercise showed the depression of ST segment in leads aV_F, V₅and V₆. 75% stenosis of right coronary artery (segment 2) and congenital coronary artery fistula originating from both the right and left coro-nary arteries were demonstrated by the coronary arteriography. One abnormal artery was originated from proximal portion of the right coronary artery (segment 1) and entered the pulmonary artery trunk. Another one was originated from proximal portion of the left coronary artery and terminated in angio-matous plexus which then communicated with the pulmonary artery trunk. We speculate that myo-cardial ischemia resulted from decreased right coro-nary blood flow due to coronary steal and proximal organic stenosis of right coronary artery. Recently, the reviews of coronary artery fistula are increasing, but coronary artery fistula with myocardial ischemia is relatively rare. This case was followed with medical therapy, because antianginal agents were effective. Operative coronary ligation may be neces-sary, if he has angina or high output heart failure during follow-up.