3枝病変に孤立性巨大冠動脈瘤を伴った1成人例

An Adult Case of Triple-vessel Disease with a Discrete Giant Coronary Aneurysm

　症例は54歳，女性である．労作時の胸痛を主訴として入院した．1990年2月に心筋梗塞の既往がある．1994年1月下旬より階段の昇降時に胸痛を自覚するようになり，近医を受診した．重症冠動脈病変が疑われ，精査加療の目的で当科を紹介された．冠危険因子として高血圧がある．心電図上，下壁誘導に異常Q波を認めた．冠動脈造影にて右冠動脈は＃4AVが完全閉塞，前下行枝は＃7に90％狭窄，左回旋枝に直径約9mmの孤立性巨大冠動脈瘤を認め，その前後の＃11および＃13にそれぞれ90％狭窄がある3枝病変であった．左室造影上，壁運動異常は認めなかった．瘤切除術と冠動脈バイパス術を施行した．術所見上，冠動脈瘤は外径18mmの半球状をしており，瘤内に多量の血栓が存在していた．本症例は3枝疾患に加え，孤立性巨大冠動脈瘤を認めた稀な症例であり，手術適応に関し，若干の文献的考察を加え報告した．

We report a rare case of tripple-vessel disease with a discrete giant coronary aneurysm. A 54-year-old female who had old inferior myocardial infarction was admitted to our hospital because of exertional chest pain. Her resting electrocardiogram showed abnormal Q wave at the inferior wall leads, and during chest pain marked ST-T changes were recognized. The coronary angiogram showed total obstruction in the distal por-tion of the right coronary artery. 90% stenosis in the proximal portion of the left anterior descending arteryand discrete giant coronary aneurysm with 90% stenosis in the front and rear of it in the mid portion of the left circumflex coronary artery. The left ventricular wall motion was good. We selected coronary artery bypass grafting and coronary aneurectomy. The exter-nal diameter of this coronary aneurysm was 18 mm and a large amount of thrombus existed in it. The histologyof this aneurysm showed arteriosclerotic change. Dis-crete atherosclerotic coronary anerysm with severe coronary stenosis should be operated on for revasculiza-tion and the prevention of thromboembolism.