高度低左心機能（駆出率12％）症例に対する準緊急冠動脈バイパス術の経験

A Case of Coronary Artery Bypass Grafting in a Patient with Severe Left Ventricular Dysfunction (LVEF 12%)

　高度左心機能低下は虚血性心疾患の予後を左右する重要な因子とされる．われわれは左室駆出率12％の梗塞後狭心症症例に対し準緊急に冠動脈バイパス術を施行し，良好な結果を得たので報告する．

　患者は57歳，男性で，急性心筋梗塞（下壁）のため入院した．冠動脈造影で＃2；90％，＃6；100％，＃13；50％，＃14；99％の狭窄を認めた．左室駆出率は12％であった．安静時再分布心筋シンチにて前壁・中隔・後下壁に著明な血流低下を認めた．PTCAを試みたが不成功であった．強力な内科的治療にもかかわらず狭心症発作が頻回に出現するため，第5病日に冠動脈バイパス術を施行した．術後長期的なドーパミン投与を必要としたが，重篤な合併症は発生しなかった．術後左室駆出率は24％に改善していた．症状は消失し，NYHA I度で現在通院加療中である．

We surgically treated a patient with postinfarction angina showing a marked reduction in left ventricular function.

The patient was a 57-year-old male who visited us because of intense chest pain. He was diagnosed as having acute myocardial infarction and was admitted. Anginal pain persisted despite intensive medical treat-ment. PTCA was unsuccessful because the guide wire could not be passed through the occluded coronary artery, and semiemergent CABG was performed on the 5th hospital day. Dopamine therapy for over 25 post-operative days was necessary. No major complications such as low cardiac output syndrome appeared, and LVEF improved to 24% postoperatively. The symp-toms disappeared, and the patient is being treated on an outpatient basis.

The prognosis of ischemic heart disease associated with severe left ventricular dysfunction is very poor. Aggressive surgical treatment is needed for improving the survival rate and quality of life.