軽微な自覚症状で経過した60歳左冠動脈肺動脈起始症の1例

A Case of an Anomalous Origin of the Coronary Artery from the Pulmonary Artery without Severe Subjective Complaints until the Patient became 60 Years Old

　高齢者の左冠動脈肺動脈起始症の1例を経験した．症例は60歳，男性，主訴は労作時の前胸部不快感ならびに息切れ，幼少期より，既に心雑音を指摘されるも放置していた．当院受診時，第三肋間胸骨左縁に最強点を有する連続性雑音を認め，心臓超音波検査では左室内腔の拡張ならびに左室のびまん性局所壁運動低下を認め，カラードップラー検査では肺動脈弁上部に血液乱流パターンを認めた．運動負荷心筋シンチグラムでは，左室前壁—側壁—心尖部領域ならびに下壁の一部—後壁領域にかけて広範囲な心筋虚血を認めた．心臓カテーテル検査の結果，左冠動脈肺動脈起始症と診断され，左→右短絡率28.7％，軽度肺高血圧，左室駆出率の中等度低下を認めたが，僧帽弁閉鎖不全は認めなかった．われわれが調べ得た範囲内では，本邦最高齢の左冠動脈肺動脈起始症の1例と思われ，文献的考察を加えて報告する．

A case of a 60-year-old man with adult type of anomalous origin of left coronary artery from the pulmonary artery (ALCP) visited our hospital for fur-ther examination of cardiac murmur that had been detected in his infancy. He was found to have a continuous murmur, the loudest in the left sternal bor-der of the third intercostal space. Examination using echocardiography detected an enlargement of the left ventriculum and diffused hypokinesia of regional wall motion of the left ventriculum. Color doppler-echocar-diography showed a pattern of turbulent blood flow in the proxymal pulmonary artery. Myocardial scinti-gram detected clear evidence of broad ischemia during the exercise stress test. Right coronary angiography revealed the existence of ALCP with a markedly devel-oped collateral circulation to the left coronary artery. The L R shunt ratio was 28.7%, and there was mild pulmonary hypertension without mitral insufficiency during cardiac catheterization. A case report of adult type of ALCP, in a patient who is the oldest survivor in Japan as far as we know, was reported with considera-tion of other cases in Japan as a reference point.