急性乳頭筋断裂術後に判明した左前下行枝の慢性閉塞病変に対する低侵襲心拍動下冠状動脈バイパス術（MIDCAB）の1例

Coronary Artery Bypass Grafting to the Left Anterior Descending Artery via Anterior Minithoracotomy after Surgery for Acute Papillary Muscle Rupture；Report of a Case

はじめに　心臓再手術の基本は胸骨再正中切開であるが，著しい低心機能や高度の癒着などで逡巡する症例も存在する．左前下行枝（LAD）へのバイパスの選択肢には，左前側方小開胸による低侵襲心拍動下冠状動脈バイパス術（MIDCAB）があり，癒着の影響を比較的受けにくく，再手術例においても安全に施行できる可能性がある．われわれは，急性心筋梗塞（AMI）に伴う乳頭筋断裂に対する僧帽弁置換術（MVR）後慢性期にMIDCABを行ったので報告する．

We presented a case with chronic occlusion of the left anterior descending artery （LAD） after mitral valve replacement （MVR）. An 80-year-old man was transferred to our hospital with a diagnosis of acute myocardial infarction. Before coronary angiography, the patient suddenly fell in a state of cardiogenic shock. Echocardiography revealed acute mitral regurgitation due to anterior papillary muscle rupture. Although emergency MVR was performed, introduction of percutaneous cardiopulmonary support （PCPS） and intraaortic balloon pumping （IABP） was needed to come off cardiopulmonary bypass. Postoperative coronary angiography revealed chronic occlusion of LAD. The left internal thoracic artery was anastomosed to LAD via anterior minithracotomy to avoid median re-sternotomy. The postoperative course was uneventful and the cardiac function improved.