心不全症状で発症した高齢者冠状動静脈瘻，巨大冠状動脈瘤の1例

Surgery in Elderly Patient for Coronary Arteriovenous Fistula and Giant Coronary Artery Aneurysm Associated with Cardiac Failure；Report of a Case

はじめに　冠状動脈と冠状静脈洞に異常交通路を形成した冠状動静脈瘻の異常血管に，動脈瘤を形成した症例を経験した．シャント率が31％と多く，初発症状は心不全症状であった．手術により良好な結果を得たので報告する．

An 82-year-old woman visited the hospital with the chief complaint of dyspnea on light exertion. Computed tomography （CT） showed a coronary artery aneurysm and coronary arteriovenous fistulas. The pulmouary flow/systemic flow （Qp/Qs） ratio was 1.4, and the left-to-right shunt rate was 31％．Two anomalous vessels were identified. One arose from the right coronary artery, formed an aneurysm, and drained into the coronary sinus, while the other originated from the distal circumflex branch and drained directly into the coronary sinus. The aneurysm measured 50×45 mm. The anomalous vessel from the right coronary artery was ligated at the sites of flow from the right coronary artery and at the site of drainage into the coronary sinus. The circumflex artery was ligated at the last branch and at the site of drainage into the coronary sinus. The aneurysm was incised and the vessel flowing into the aneurysm was sutured closed. Postoperative CT showed no anomalous blood vessel and the circumflex artery was visualized up to the last branch.