高齢者の左冠状動脈肺動脈起始症に対する冠状動脈バイパス術

Coronary Artery Bypass Grafting in an Elderly Patient with Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

左冠状動脈肺動脈起始症（ALCAPA）は，左冠状動脈（LCA）が肺動脈（PA）から起始するまれな先天性心疾患である．LCAの低酸素飽和度や低血流によって心筋虚血が起き，左室拡大や二次性の僧帽弁閉鎖不全（MR）を発症するのが特徴であり，自然予後は不良である1）．われわれは高齢者ALCAPAに対し，冠状動脈バイパス術（CABG）およびLCA入口部直接閉鎖術を施行した1例を経験したので報告する．

We report a case of a 73-year-old woman who was diagnosed with anomalous origin of the left coronary artery （LCA） from the pulmonary artery （ALCAPA） by coronary angiography. Drug stress myocardial perfusion scintigraphy demonstrated myocardial ischemia in the left anterior descending coronary artery （LAD） region. She underwent single coronary artery bypass grafting to LAD using left internal thoracic artery （LITA） and direct closure of the origin of the anomalous LCA. Postoperative coronary catheterization revealed a patent graft showing no residual shunt from the pulmonary artery into the left coronary artery. Myocardial scintigraphy proved improvement of the ischemia. In general, once ALCAPA is diagnosed, early surgical intervention is recommended. However, since there are few reports regarding surgical treatment for ALCAPA in elderly patients, the optimal treatment strategy is not completely established. Therefore careful long-term follow-up is mandatory.