心原性ショックで発症した急性心筋梗塞に対して左主幹部と右冠動脈入口部にステントを植え込み救命しえた特発性間質性肺炎合併の1例

A Case with Myocardial Infarction and Cardiogenic Shock Accompanied with Interstitial Pneumonia Rescued by Successful Percutaneous Transluminal Coronary Angioplasty and Stent Applied to Ostial Lesions of the Left Main Trunk and the Right Coronary Artery

　73歳の男性で基礎疾患に特発性間質性肺炎があり，労作時息切れのため入院した．入院後3日目に心原性ショックとなった．人工呼吸器管理下，大動脈バルーンパンピングを挿入し，冠動脈造影を施行したところ，左冠動脈主幹部と右冠動脈入口部に狭窄を認めた．この部の強い虚血によりショック状態を引き起こしたと考えられた．冠動脈ステント留置術を左冠動脈主幹部と右冠動脈入口部に施行し狭窄の拡張に成功した．その後，徐々に状態は改善し退院するまでとなった．左冠動脈主幹部と右冠動脈入口部がいずれも完全閉塞でなく，冠動脈ステント留置術を施行しやすかったことなどが救命できた大きな要因であったと推測された．特発性間質性肺炎と冠動脈硬化の関連性はないと考えられ，冠動脈ステント留置術を左冠動脈主幹部に施行して救命することでさえ困難なうえに，特発性間質性肺炎も伴っており救命されたことは非常に稀と考えられ報告した．

In a patient with interstitial pneumonia, who had developed cardiogenic shock due to ostial lesions of the left main trunk and right coronary artery, the applica-tion to those lesions of percutaneous transluminal coro-nary angioplasty (PTCA) and Stent was attempted. Followed by the insertion of an intra-aortic balloon, at first, dilation of the ostial stenosis of the right coronary aretry was performed. Following that, Palmaz-Schaz stent was deployed successfully. PTCA and Stent im-plantation to the left main trunk stenosis was also performed successfully. The patient gradually recovered after these successful procedures. The main factors affecting the patient favorably were that the main disease on the left side was not a total occlusion but 90% stenosis, and that PTCA and Stent deployment to both ostial lesions were easy. It is very rare to be able to rescue a patient with cardiogenic shock due to ostial lesions of the left main trunk and right coronary artery accompanied with interstitial pneumonia by successful application of PTCA and Stent to those lesions.