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Kokyu to Junkan Volume 38, Issue 6 （June 1990）

呼吸と循環 38巻6号（1990年6月発行）

Japanese English

症例

原発性冠動脈解離の1例 A case of primary coronary artery dissection 西野雅巳 ¹ , 加藤順司 ¹ , 江角章 ¹ , 野崎士郎 ¹ , 西野佳秀 ¹ , 棚橋秀生 ¹ , 安野雅夫 ¹ , 小林敬司 ¹ , 山田義夫 ¹ , 阿部裕 ¹ Masami Nishino ¹ , Junji Kato ¹ , Akira Ezumi ¹ , Shiro Nozaki ¹ , Yoshihide Nishino ¹ , Hideo Tanahashi ¹ , Masao Yasuno ¹ , Keiji Kobayashi ¹ , Yoshio Yamada ¹ , Hiroshi Abe ¹ ¹大阪労災病院内科 ¹The Departmem of Internal Medicine, Osaka Rosai Hospital キーワード：原発性冠動脈解離（primary coronary artery dissection） , 冠動脈造影（coronary angiography） , 冠攣縮（coronary vasospasm） Keyword: 原発性冠動脈解離（primary coronary artery dissection） , 冠動脈造影（coronary angiography） , 冠攣縮（coronary vasospasm） pp.589-593

発行日 1990年6月15日 Published Date 1990/6/15

DOI https://doi.org/10.11477/mf.1404900165

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Abstract 文献概要
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　患者は52歳，男性。約1時間続く胸痛あり，その後も胸部不快感が続くので本院内科を受診。心電図とCPKの値より急性下壁梗塞の可能性が強かったが確診に至らず緊急冠動脈造影は施行せず本院CCUへ人院。以後CPK上昇し下壁梗塞と診断されたが，Forrester Iの状態で順調に経過。発症1ヵ月後冠動脈造影を行ったところ右冠動脈の原発性冠動脈解離と診断された。6ヵ月後の再冠動脈造影では右冠動脈のfalse lumenは造影されず解離部近位端と遠位端に狭窄を認めた。

　原発性冠動脈解離は剖検例の報告がほとんどであったが近年の冠動脈造影法の発達，普及により生前診断例が増加し文献上生前診断例は46例にのぼる。生存例は死亡例に比べ右冠動脈解離が多く，比較的男性に多かった。原因については冠攣縮の関与がいわれているが本例ではアセチルコリン負荷陰性であった。治療法については確立された方法はないが他の虚血性心疾患に準ずればよいと考えられた。

Primary coronary artery dissection occuring as a spontaneous event and not associated with trauma due to catheter manipulation is rare. We recently experienced (a case of) a 52-year-old man with pri-mary artery dissection. He was admitted to our hospital with severe chest pain as his chief com-plaint on September 6, 1988. Electrocardiography and laboratory data showed acute inferior myo-cardial infarction. He was treated with medication and underwent coronary angiograms on October 3, 1988. Right coronary angiogram revealed an intimal flap and false lumen. But right coronary angio-grams 6 months after the onset of myocardial in-farction revealed progression of stenosis but no intimal flap, and coronary spasm was not evoked after acetylcholine administration.

Primary coronary artery dissection has been re-ported since Pretty's first description of it in 1931. The majority of earlier cases were diagnosed at autopsy, but recently reports of survivors have been increasing due to the progress in and popular-ization of coronary angiographic technics. This case is the 46th case of primary coronary dissection found by coronary angiography. So it is not extremely rare.

In our case the involved artery was the right coronary artery. In survivors, right coronary artery dissection is more frequent than left, because the area supplied by the right coronary artery is smal-ler than the area supplied by the left one.

Although in our case coronary artery stenosis progressed, after a long term resolution of dissec-tion may occur. There are a few cases in which resolution of dissection occurred naturally.

There is no established treatment of primary coronary artery dissection, but, as a rule, this also applies to the treatment of other ischemic heart diseases.