急性心筋梗塞をきたした巨大右冠状動脈瘤の1例

Giant Right Coronary Artery Aneurysm Causing Acute Myocardial Infarction；Report of a Case

はじめに　冠状動脈瘤は通常血管径の1.5倍以上の血管径と定義されている．巨大冠状動脈瘤は2 cm以上の血管径と定義されるが，頻度としては少ない．冠状動脈瘤の80％以上は後天性で動脈硬化性によるものであり，しばしば無症状である．しかし狭心症，心筋梗塞，破裂，周囲組織の圧排による血行動態悪化，突然死など重篤な経過をたどる可能性もある．巨大右冠状動脈瘤から急性心筋梗塞をきたした症例を経験したので報告する．

We report a case of giant right coronary artery aneurysm causing acute myocardial infarction. A 59-year-old man presented with syncope and referred to our hospital in ambulance. Electrocardiogram showed acute myocardial infarction of the right coronary artery, and emergent coronary angiography was performed. Angiography confirmed a giant coronary artery aneurysm in the mid-portion of the right coronary artery. He underwent aneurysmectomy and coronary artery bypass grafting to the posterior descending artery. Spontaneous rupture of a giant coronary artery aneurysm is rare, but critical condition such as acute myocardial infarction or fistula to heart chamber can occur. Surgical intervention is indicated for a giant coronary artery aneurysm to prevent possible life-threatening consequences in the future.