右冠状動脈起始異常による狭心症の1例

Angina Pectoris due to Anomalous Aortic Origin of the Right Coronary Artery；Report of a Case

はじめに　右冠状動脈（RCA）が左Valsalva洞から起始するRCA起始異常（AAORCA）はまれな冠状動脈奇形であるが1），RCAが大動脈（Ao）と肺動脈（PA）間を走行する場合は若年者の突然死の原因となるため，治療を要する2～4）．われわれが経験した，AAORCAが原因であった狭心症に対する手術例を報告する．

A 45-year-old woman was admitted to our hospital because of chest pain on exertion. She was diagnosed to have an anomalous aortic origin of the right coronary artery （RCA） arising from the left sinus of Valsalva, passing between the aorta and the main pulmonary artery. Exercise treadmill test demonstrated significant depression of ST segments in leadsⅡ，Ⅲ and aVF．Because medical treatment was ineffective, reimplantation of the RCA was performed. Dysfunction of the reimplanted RCA occurred, however 3 hours after surgery, and emergency coronary artery bypass grafting was performed using a saphenous vein graft to the RCA. After the 2nd operation, postoperative course was uneventful and multidetector row computed tomographic angiography revealed the patent vein graft and narrowing of the relocated site of RCA.