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はじめに 冠状動脈肺動脈起始症はまれな先天性心疾患であり,中でも右冠状動脈肺動脈起始症(ARCAPA)の発症頻度は0.002%と推定されている1).幼少期を無症状で経過し,成人後に発症するARCAPAの症例報告は散見されるが,外科的治療方法は確立されていない.われわれは,老年期に心不全を発症し,瘻孔閉鎖術と冠状動脈バイパス術(CABG)を施行した症例を経験したので報告する.
An anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital disease, and it sometimes remains unnoticed until cardiac symptoms appear in adulthood. We report an adult case of surgically treated ARCAPA. A 72-year-old male was diagnosed with ARCAPA by examination for heart failure. The origin of the right coronary artery (RCA) was dilated, and ischemic change was found in the RCA area by myocardial scintigraphy. Therefore, coronary artery bypass grafting to distal RCA was performed at first, then the fistula was closed using an autologous pericardial patch, and the dilated origin of RCA was resected. Postoperative scintigraphy showed disappearance of the ischemic pattern, and the patient was discharged without any symptom of heart failure.
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