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Kokyu to Junkan Volume 37, Issue 11 （November 1989）

呼吸と循環 37巻11号（1989年11月発行）

Japanese English

症例

PTCRおよび緊急CABG，ならびに安定期PTCAにより救命のみならず社会復帰が可能になった左冠動脈主幹部病変心筋梗塞症の1例 A case of myocardial infarction due to the left main trunk lesion, in which percutaneous coronary recanalization and emergency coronary-aorto bypass graft, and subsequent percutaneous coronary angioplasty were effective not only from a viewpoint of survival but from comeback to social life 三国谷淳 ¹ , 菊池文孝 ¹ , 花田裕之 ¹ , 田村太志 ¹ , 戸塚英徳 ¹ , 小野寺庚午 ¹ , 鯉江久昭 ² , 及川光雄 ³ , 大池弥三郎 ⁴ Atsushi Mikuniya ¹ , Fumitaka Kikuchi ¹ , Hiroyuki Hanaba ¹ , Futoshi Tamura ¹ , Hidenori Totsuka ¹ , Kogo Onodera ¹ , Hisaaki Koie ² , Mitsuo Oikawa ³ , Yasaburo Oike ⁴ 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弘前中央病院内科 ⁴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 Departrnent of Surgery, Hirosaki University School of Medicine ³Department of Medicine, Hirosaki Chuo Hospital ⁴Reimeikyo Rehabilitation Hospital pp.1237-1242

発行日 1989年11月15日 Published Date 1989/11/15

DOI https://doi.org/10.11477/mf.1404205584

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Abstract 文献概要
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　左冠動脈主幹部（LMT）病変による急性心筋梗塞症は早期に致命的となる予後不良の疾患であるが1），心筋梗塞急性期に経皮経管的冠動脈再疎通術（PTCR）^2）ならびに緊急冠動脈—大動脈バイパス術（CABG）^3），さらに安定期に経皮経管的冠動脈形成術（PTCA）^4）を施行することにより救命のみならず社会復帰が可能になった1症例を経験した。若干の考察を加えて報告する。

A case of acute myocardial infarction due to the lesion in the left main coronary artery was repor-ted.

A 50-year male was referred to our department for suspected acute myocardial infarction. Physical examination on admission revealed slight cyanosis with cold sweating due to severe chest pain. Pulse was irregular and heart rate was 78 beats/ min. Blood pressure was 100/80 mmHg. A series of electrocardiogams (ECG) and labolatory data pro-vided the diagnosis of wide-ranged anterolateral infarction in the left ventricle.

Emergency coronary angiograms taken without delay showed a subtotal occlusion (99% stenosis) of the left main coronary trunk (LMT) before the initiation of intracoronary thrombolysis (PTCR). Following the intracoronary infusion of urokinase of 1,200,000 units, symptoms and ECG changes transiently improved but worsened later, and LMT stenotic lesion and delayed filling of myocardium were similar with before PTCR. Emergency coro-nary-aorto bypass graft (CABG) was undertaken without a significant delay to both the left anterior descending artery (LAD) and left circumflex coro-nary artery (LCX). With these treatments, the patient could survive despite the wide area of in-farction due to LMT lesion.

Coronary angiograms performed 37 days after the CABG showed that the graft to LAD was completely occluded and the LCX graft was patent with partial stenosis. Treadmill test at this time induced an anginal episode with ischemic ECG changes on moderate exercise, indicating the pre-sence of significant area of ischemic myocardium.For salvage of the ischemic myocardium, percutan-eous transluminal coronary angioplasty (PTCA) was successfully performed for the LMT stenosis, resul-ting in no episode of angina nor ischemic ECG changes during exercise loading.

PTCR and emergency CABG, followed by PTCA at a stable condition, may be effective procedures for infarcted patients of LMT lesion in a sense of not only survival but comeback to social lives.