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Kokyu to Junkan Volume 47, Issue 9 （September 1999）

呼吸と循環 47巻9号（1999年9月発行）

Japanese English

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症例

左前下行枝近位部から生じた血栓の伸展が原因と思われた左主幹部心筋梗塞の1例 Acute Myocardial Infarction with Left Main Artery Obstruction, Probably Caused by Thrombus Extending from the Proximal Left Anterior-descending Coronary Artery 鈴木直紀 ¹ , 日浅芳一 ¹ , 原田貴史 ¹ , 山下潤司 ¹ , 宮本弘志 ¹ , 高橋健文 ¹ , 細川忍 ¹ , 谷本雅人 ¹ , 岸宏一 ¹ , 大谷龍治 ¹ Naoki Suzuki ¹ , Yoshikazu Hiasa ¹ , Takashi Harada ¹ , Jyunji Yamashita ¹ , Hiroshi Miyamoto ¹ , Takefumi Takahashi ¹ , Shinobu Hosokawa ¹ , Masato Tanimoto ¹ , Koichi Kishi ¹ , Ryuji Otani ¹ ¹小松島赤十字病院循環器科 ¹Division of Cardiology, Komatsushima Red Cross Hospital キーワード：左主幹部閉塞 , 急性心筋梗塞 , 経皮的冠動脈形成術 , left main coronary artery , acute myocardial infarction , percutaneous transluminal coronary angioｐlasty（PTCA） Keyword: 左主幹部閉塞 , 急性心筋梗塞 , 経皮的冠動脈形成術 , left main coronary artery , acute myocardial infarction , percutaneous transluminal coronary angioｐlasty（PTCA） pp.957-961

発行日 1999年9月15日 Published Date 1999/9/15

DOI https://doi.org/10.11477/mf.1404901968

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　症例は43歳，男性．胸痛にて近医を受診し，心電図にてV₂〜V₆，I，aV_L誘導にてSTの上昇と下壁誘導にてSTの低下を認めた．発症約2.5時間後に当院に救急搬送された．来院時には心原性ショックの状態であった．当院での心電図は，左主幹部閉塞に典型的な心電図変化を示した．緊急冠動脈造影では左主幹部および左前下行枝，左回旋枝に血栓像を伴う99％の狭窄を認めた．右冠動脈には有意狭窄は認めなかった．経皮的心肺補助装置を挿入した後，左主幹部に対し直接冠動脈形成術，ステント留置術を行った．3ヵ月後の慢性期冠動脈造影では左主幹部に有意狭窄は認めず，左室駆出率は38％であった．退院後約10ヵ月を経過した現在も無症状である．臨床経過，心電図経過および緊急冠動脈造影所見から，左前下行枝近位部に生じた冠動脈内血栓が左主幹部および左回旋枝に伸展したと考えられた．このような例は非常に稀と考えられ報告した．

　A 43-year-old man presenting chest pain was admitted to a nearly hospital. His initial electrocardiogram showed ST-segment elevation in V₂~V₆. I, V_L. Then he was brought to our hospital2.5 hours after onset of the symptoms. He was in cardiogenic shock on admission, His electrocardiogram in our hospital revealed typical findings of obstruction of the left main coronary artery. Emergency coronary angiography was performed immediately. The left main trunk, left anterior descending artery and left circumflex branch had 99% obstruction with thrombus. The right coronary artery had no significant stenosis. We performed direct percutaneous transuminal angioplasty (PTCA) immediately with Multi-Link^® stent placement under percutaneous cardiopulmonary bypass support. After the proceduire, intraaortic balloon counterpulsation was performed. The percutaneous cardiopulmonary bypass support was removed 3 days after, and the intra-aortic balloon counterpulsation was removed 6 days after PTCA. Coronary angiography and left velltriculography were perforlned 3 months later. We found no restenotic lesion in the left coronary artery and left ventricular ejection fraction was 38%. The patient is alive and asymptomatic 10 months later.

　His clinical course, electrocardiogram changes and angiographical findings suggested that the thrombu sextending from the proximal left anterior-descending coronarv artery caused left main coronary artery obstruction.