心タンポナーデを契機に発見された冠状動脈肺動脈瘻の1例

Coronary-pulmonary Artery Fistula Manifested by Cardiac Tamponade；Report of a Case

はじめに　冠状動脈瘻は比較的まれな先天性心疾患であり，自覚症状はほとんどなく，冠状動脈造影（CAG）や心臓CTなどで偶然発見されることが多い1）．無症状であっても未治療の場合には，心不全や肺高血圧症，感染性心内膜炎のリスクがあるため，治療介入のタイミングが重要である．われわれは，心タンポナーデを契機に発見された冠状動脈肺動脈瘻（CPAF）の1例を経験し，良好な結果を得たので報告する．

Coronary-pulmonary artery fistula （CPAF） is a relatively rare congenital malformation. We successfully treated a patient who presented with cardiac tamponade due to ruptured CPAF. A 58-year-old woman was admitted to our hospital due to consciousness disorder. Enhanced computed tomography revealed hemopericardium, and she was diagnosed with cardiac tamponade due to a ruptured coronary artery aneurysm with fistula arising from the right coronary and entering the main pulmonary artery. Therefore, emergency operation was performed. Under cardiopulmonary bypass, the aneurysm was opened and the ostium of the fistula was closed with pledgetted mattress sutures. After ligating the tortuous CPAF, the aneurysmal wall was sutured. Postoperative course was uneventful, and she was discharged on postoperative day 16.