雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Kokyu to Junkan Volume 38, Issue 8 （August 1990）

呼吸と循環 38巻8号（1990年8月発行）

Japanese English

症例

意識消失発作を主訴とし緊急手術にて救命し得た左冠動脈主幹部病変の3例 Three operated cases of LMT-lesion with chief complaint of syncorpal attack 佐々寛己 ¹ , 曽根孝仁 ¹ , 坪井英之 ¹ , 浅野博 ¹ , 村瀬允也 ² , 前田正信 ² , 村上文彦 ² , 寺西克仁 ² Hiromi Sassa ¹ , Takahito Sone ¹ , Hideyuki Tsuboi ¹ , Hiroshi Asano ¹ , Mitsuya Murase ² , Masanobu Maeda ² , Fumihiko Murakami ² , Katsuhito Teranishi ² ¹大垣市民病院循環器科 ²大垣市民病院胸部外科 ¹Department of Cardiology, Ogaki Municipal Hospital ²Department of Thoracic Surgery, Ogaki Municipal Hospital キーワード：左主幹部病変（left main trunk lesion） , 意識消失発作（unconsciousness attack） , 緊急A-Cバイパス術（emergency A-C bypass surgery） Keyword: 左主幹部病変（left main trunk lesion） , 意識消失発作（unconsciousness attack） , 緊急A-Cバイパス術（emergency A-C bypass surgery） pp.815-818

発行日 1990年8月15日 Published Date 1990/8/15

DOI https://doi.org/10.11477/mf.1404900200

PDF(5831KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

　意識消失発作を主訴として緊急入院し，心電図所見より左冠動脈主幹部（LMT）病変を疑って緊急冠動脈造影（CAG）に引き続く緊急冠動脈バイパス術（A-C bypass術）を行い救命し得た3例を経験した。

　症例1は71歳，男。心電図にてaV_R，aV_LにてST上昇と他の誘導にてST低下を認め，緊急CAGにてLMTに80％狭窄が認められた。症例2は51歳，男。心電図にてI，II，III，aV_F，V₁〜V₆におけるST低下，aV_RにおけるST上昇を認め，緊急CAGにてLMTに70％狭窄を認めた。症例3は75歳，男。心電図にてaV_R，aV_LにST上昇を認め，緊急CAGにてLMTに60％狭窄を認めた。症例1は外来到着後2時間半後，症例2は同じく2時間50分後，症例3は24時間後にA-C bypass術を施行し救命し得た。

　結語：意識消失発作の患者で，心電図にて広範且つ高度のST低下，aV_R，aV_LにおけるST上昇を認めたらLMT病変を疑って緊急CAGを行い，緊急A-C bypass術を考える必要がある。

An urgent aorto-coronary bypass operation (AC-bypass) was made in three patients with unstable angina pectoris, suffering from stenosis of the left main trunk (LMT). All patients were admitted with chief complaints of chest discomfort and syncorpal attack.

Case 1 was a 71 year-old man who suffered with chest discomfort and syncorpal attack. He was ad-mitted to our emergency room by ambulance 40 minutes after the syncorpal attack, on January 11, 1989. His blood pressure was 140/96; pulse 84 and regular. The electrocardiogram (ECG) showed right bundle branch block, ST elevation in aVR, aVL and ST depression in all other leads. Coronaryarterio-gram (CAG) was made urgently and showed 80% stenosis in LMT. The emergency AC-bypass opera-tion was successfully carried out about 3 hours and 10 minutes after the onset of symptoms.

Case 2 was a 51 year-old man who suffered from precordial oppression and syncorpal attack. He was admitted to our emergency room by ambulance about 1 hour after the attack, on January 17, 1989. His blood pressure was 94/74 ; pulse 120 and irregular. Chest radiography showed a cardiothoracic ratio of 58% and the ECG disclosed atrial fibrillation, ST elevation in aVR and ST depression in I, II, III, aVF, V1-6. The echocardiogram revealed hypokinetic motion in the antero-lateral wall of the left ven-tricle. CAG was carried out without delay, and showed 70% stenosis with slit in LMT.

An emergency AC-bypass operation was succes-sfully carried out about 3 hours and 50 minutes after the onset of symptoms.

Case 3 was a 75 year-old man with syncorpal at-tack as his chief complaint. He was also suffering from anteroseptal infarction. He was admitted to our hospital by ambulance 40 minutes after the attack, on February 7, 1989. The blood pressure was 145/80; pulse 126 and irregular. On auscultation, moist rales were heard on the bases of the lung. The chest radio-graphy showed a cardiothoracic ratio of 60% and pulmonary congestion. The ECG revealed atrial fibrillation, complete right bundle branch block, abnormal Q in V_1-5, ST elevation in aVR, aVL and ST depression in I, II, III aV_F, V_1-6.

Urgent CAG was made and showed 60% stenosis with haze in LMT. Because circulatory state was stable, AC-bypass operation was made next day, successfully.

The postoperative courses were uneventful in all three patients.