重症大動脈弁狭窄症を合併した冠状動脈瘻の1例

Coronary Artery Fistula with Aortic Valve Stenosis：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，先天性心疾患の0.04〜0.1％を占め，冠状動脈の先天性心疾患としてはもっとも頻度が高い1，2）．われわれは，重症大動脈弁狭窄症に冠状動脈-肺動脈瘻と気管支動脈-肺動脈瘻を合併した症例に対して外科的切除術を施行した．本例のように両側冠状動脈-肺動脈瘻に気管支動脈-肺動脈瘻を合併した症例は非常にまれであるため，文献的考察を加え報告する．

A coronary artery fistula usually originates in the right coronary artery and often opens into the right ventricle. In approximately 50％ of cases with a main pulmonary artery opening, aberrant blood vessels originate from both coronary arteries. Only a few cases of both coronary and bronchial artery-pulmonary artery fistulas have been reported. The patient was an 83-year-old man. Echocardiography showed severe aortic stenosis, while coronary angiography revealed aberrant vessels from both coronary arteries to the pulmonary artery. The right heart catheterization revealed a 26％ left-to-right shunt ratio and a pulmonary/body blood flow ratio （Qp/Qs） of 1.36. MDCT scan confirmed that the aberrant vascular plexus originating from both coronary arteries was connected to the bronchial artery. We performed surgery on the patient, replacing the aortic valve and resecting the coronary arteriovenous fistulas. On the 11th postoperative day, the shunt had disappeared, as evidenced by a 1.2％ left-to-right shunt ratio and a Qp/Qs of the right heart catheterization of 1.02. The patient progressed uneventfully and was discharged on the 25th postoperative day.