ほぼ同時に発生したと考えられた冠動脈2枝の硬化斑破裂による多発性急性心筋梗塞の1剖検例

Multiple Acute Myocardial Infarction Possibly Induced by Simultaneous Multivessel Coronary Plaque Ruptures:An autopsy case

　主要冠動脈2枝に発生した硬化斑破裂とそれに伴う閉塞性血栓を原因とする多発性急性心筋梗塞の剖検症例について報告する．症例は73歳男性で，発症直後に心停止を来し，それから蘇生した後6日目に死亡した．病理解剖にて2つの貫壁性心筋梗塞病巣が認められ，うち1病巣は左室後壁と右室後壁にまたがる領域で，右冠動脈近位部の硬化斑破裂と閉塞性血栓を原因とし，他の1病巣は左室前壁領域で，左前下行枝から分岐する対角枝の硬化斑破裂と閉塞性血栓によるものであった．経時的変化を呈する梗塞部心筋と冠動脈血栓は両者ともに同一な組織形態であり，2つの梗塞病巣はほぼ同時に発生したと考えられた．同時多発性の硬化斑破裂の誘因については，左右冠動脈にほぼ同時に発生した攣縮が推定された．

A case of multiple fresh myocardial infarction sup-posed to have occurred simultaneously was reported. Autopsy of a 73-year-old male who died after 6 days of illness, revealed two independent lesions of transmural infarction. One lesion was in the posterior wall of the left ventricle and the posterolateral wall of the right ventricle, and the other was in the anterior wall of the left ventricle. The two infarctions were caused by coronary plaque rupture and thrombosis of the arteries perfusing those regions, viz. right coronary artery and diagonal branch of the left anterior descending branch,respectively. Almost identical pathomorphological findings of the two infarcted myocardia and coronary thromboses were highly suggestive of their simultane-ous occurence. The inducing factor of the two coronary plaque ruptures was suspected to be multivessel coro-nary spasm.