MDCTで描出された巨大冠状動脈瘤を伴った冠状動脈肺動脈瘻の1例

Coronary Artery to Pulmonary Artery Fistula with a Large Coronary Artery Aneurysm Detected by Multi-detector Row Computed Tomography；Report of a Case

はじめに　冠状動静脈瘻は冠状動脈造影検査の普及により0.1～0.2％に認められるとの報告があるが1），冠状動静脈瘻に合併する冠状動脈瘤の報告は比較的まれである2）．われわれは巨大冠状動脈瘤を伴った冠状動脈肺動脈瘻の手術例を経験し，MDCTによる術前における冠状動脈肺動脈瘻の三次元的位置把握が有用であったので，文献的考察を加えて報告する．なお，われわれが調べえた限りで冠状動脈肺動脈瘻に伴った冠状動脈瘤では本邦最大瘤径であった．

We report a case of coronary artery to pulmonary artery fistula with a large coronary artery aneurysm （80 mm）. A 62-year-old man was referred to our hospital because of syncope without heart failure. Electrocardiogram abnormality and asynergy in the anteroseptal wall were detected on echocardiography. Coronary angiography and multi-detector row computed tomography （MDCT） showed a large coronary artery aneurysm and coronary artery to pulmonary artery fistula originating from the right coronary artery （RCA）, left main trunk （LMT） and left anterior descending artery （LAD）. The fistula was treated using ligation and endocardial closure, and the aneurysm was resected without coronary artery bypass grafting. Postoperatively, MDCT showed that the fistula and aneurysm had disappeared. MDCT was useful for understanding the spatial relation of the coronary artery to pulmonary artery fistula.