心タンポナーデをきたした巨大冠状動脈瘤破裂

Cardiac Tamponade due to a Ruptured Giant Coronary Artery Aneurysm

冠状動脈瘤は冠状動脈造影の0.3～5％に認め，まれな疾患である1）．なかでも径が40 mmを超えるものは巨大冠状動脈瘤と呼ばれ2），頻度は0.02％と報告されている3）．また，冠状動脈瘤破裂の報告のほとんどは冠状動脈瘻合併例であり4），冠状動脈瘻合併がないものはまれである．われわれは，瘤径56 mmの巨大冠状動脈瘤破裂による心タンポナーデをきたした1例を経験したので，若干の文献的考察を加えて報告する．

We report a case of a ruptured coronary artery aneurysm. An 87-year-old woman suffered from cardiac tamponade due to a ruptured coronary artery aneurysm. Coronary angiography showed a giant coronary aneurysm without coronary artery fistula. Emergency surgery was performed through median sternotomy. We performed aneurysmectomy and ligation of the perfusion arteries under cardiopulmonary bypass. The patient’s postoperative course was uneventful. We also reviewed nine cases of ruptured coronary artery aneurysm without coronary artery fistula in Japan. The disease is a rare clinical state and considered to be an indication for emergency surgery.