冠状動脈バイパス術後に胸肋鎖骨肥厚症が判明し治療に難渋した1例

Coronary Artery Bypass Grafting complicated with sternocostoclavicular hyperostosis；Report of a Case

はじめに　冠状動脈バイパス術（CABG）において内胸動脈グラフトの使用は，生存率，心事故回避率，良好な開存率の点からゴールデンスタンダードとなっている．しかし，内胸動脈グラフトの狭小や採取時の損傷の場合，使用できずにグラフトデザインを変更せざるをえない場合がある．われわれは胸肋鎖骨肥厚症を合併したCABGにおいて，内胸動脈剝離が困難で使用不可能となり，治療に難渋した症例を経験したので報告する．

The patient was 72-year-old man, who had old myocardial infarction, diabetes mellitus, dyslipidemia, hypertension and chronic obstructive pulmonary disease. He was complicated with congestive heart failure, and multi-vessel coronary artery disease and moderate aortic valve stenosis and regurgitation were diagnosed. We performed coronary artery bypass grafting （CABG） and aortic valve replacement. Intraoperative findings showed severe adhesions and tissue fibrosis around sternum. It was very difficult to dissect adhesions around left internal thoracic artery （LITA）. LITA was injured, and great saphenous vein was anastomosed to left anterior descending coronary artery. Sternocostoclavicular hyperostosis was diagnosed on computed tomography （CT） findings such as remarkably thickened sternum and adhesion of sternoclavicular joint. Postoperative course was complicated by osteomyelysis and necrosis of left side skin incision, for which omentopexy was needed.

Sternocostoclavicular hyperostosis is rare disease, but we should recognize in preoperative evaluation.