急性冠症候群に対する緊急経皮的冠動脈形成術後に確定診断され緊急心臓大血管手術を施行した2症例

Case Reports of Emergency Cardiovascular Procedures Following Emergency Percutaneous Coronary Interventions for Acute Coronary Syndrome

要旨　症例1は74歳女性．安静時胸痛発作のため救急搬送された．救急外来にて蘇生術が施行され急性冠症候群(ACS)の診断下に左回旋枝完全閉塞に対し薬剤溶出性ステント(DES)による経皮的冠動脈形成術(PCI)が施行された．PCI後心不全遷延し乳頭筋断裂と診断され当科紹介，同日緊急手術となった．症例2は55歳男性．突然の左前胸部痛のため救急搬送された．ACSの診断下に右冠動脈起始部にDES留置後上行大動脈に造影剤の滞留を認めスタンフォードA型解離の診断下同日緊急手術となった．2症例とも手術時間，心停止時間短縮のため冠動脈バイパス術は施行せずDES早期血栓閉塞を回避し得た．頻度は少ないが初期診断の時点からACSの合併症を判断し，原因について診断可能なハートチーム形成が望まれる．

　Case1 is a 74-year-old female presented to our emergency unit for ongoing chest pain. An emergency coronary angiogram revealed total occlusion of the left circumflex coronary artery, and percutaneous coronary intervention(PCI)was performed using drug eluting stents(DES). The papillary muscle rupture was found after procedure, then emergency mitral valve replacement was performed.

　Case 2 is a 55-year-old male transferred by ambulance for acute chest pain. An emergency PCI was performed to the right coronary ostium occlusion using DES, then the aortogram showed contrast dye staining of ascending aorta. An emergency graft replacement of ascending aorta was performed for acute type A dissection.

　The coronary artery bypass grafting was avoided in both cases. Both patients were well tolerated cardiopulmonary bypass procedures and postoperative courses were uneventful.