日齢5日に循環不全となり緊急でのパッチ閉鎖が有効であった冠状動脈瘻の1例

Emergency Patch Closure of Coronary Artery Fistula During the Neonatal Period；Report of a Case

はじめに　冠状動脈瘻（CAF）は比較的まれな疾患であり，先天性心疾患の0.2～0.4％を占める1）とされているが，自然治癒の期待はできず，手術治療が多く選択される疾患である．未治療で経過する例も多く治療介入時の年齢層も広く，瘻孔関与血管や瘻孔部位，瘻孔数にさまざまなタイプが存在し，ほかの心疾患の合併も認めるため，症例ごとの治療戦略の検討が必要とされる．われわれは新生児期に循環不全に陥ったCAF例を経験し，良好な結果を得たので文献的考察を加え報告する．

We describe surgical treatment of a coronary artery fistula （CAF） in a neonate. A 5-day-old male neonate was diagnosed with CAF at another hospital and was transferred to our hospital. Transthoracic echocardiography revealed a right coronary artery-to-right ventricle （RV） fistula. Emergency surgery was performed to treat progressive congestive heart failure due to a significant left-to-right shunt through the large CAF. Intraoperatively, we confirmed that the large CAF drained into the inlet of the RV through multiple openings. Intracardiac CAF closure was performed with a bovine pericardial patch. The neonate showed an uneventful postoperative recovery, and postoperative echocardiography revealed a trivial residual shunt with good left ventricular function without increased pulmonary artery pressure.