巨大右冠状動脈仮性動脈瘤に対する1例

Giant Right Coronary Artery Pseudoaneurysm：Report of a Case

はじめに　冠状動脈瘤は局所的な冠状動脈の拡張病変で，正常冠状動脈径の1.5倍以上と定義される1，2）．中でも40 mmを超える冠状動脈瘤は巨大冠状動脈瘤とされ3），その治療方針に関しては一定の見解を得られていない．われわれは，巨大右冠状動脈仮性動脈瘤に対して手術を行った1例を経験したため報告する．

Giant coronary artery aneurysm is very rare and there is no clear consensus regarding its treatment. Herein, we report a case of this unusual entity. The patient was a 75-year-old man in whom follow-up coronary angiography showed leakage of contrast agent from one of the #4 posterior descending （#4PD） branch of the right coronary artery. Enhanced computed tomography （eCT） revealed a giant pseudoaneurysm with a maximum diameter of 55 mm. Percutaneous balloon angioplasty had been performed in the same vessel for angina pectoris 20 years earlier. We excluded the pseudoaneurysm from arterial perfusion by closing both the wall defect and the culprit branch under cardiopulmonary bypass. There was no need for revascularization because there was another #4PD branch nearby. No adverse events were observed after surgery. Postoperative eCT scans confirmed that the aneurysm was completely thrombosed with no leakage.