肺動脈主幹部切離を要した冠状動脈瘻

Pulmonary Artery Transection in Surgery for Coronary Artery Fistula

冠状動脈瘻は冠状動脈が心房，心室あるいはその他の脈管と異常な交通をもつまれな疾患である．起始部と流出部のパターンは多岐にわたっており，定型的な治療方針は確立されていない．治療適応，治療方法（経皮的，外科的），外科的治療の術式などについては症例ごとに検討される．われわれは，左冠状動脈主幹部周囲に病変をもつ冠状動脈瘻に対して肺動脈主幹部切離により良好な視野で手術を行った1例を経験したので，若干の文献的考察を加え報告する．

Coronary artery fistula is a rare abnormality in the communication between a coronary artery and any of the cardiac chambers or major vessels. At present, there is no standard surgical treatment and the most appropriate method is selected on a case-by-case basis. We report one case of coronary artery fistulae in which pulmonary artery transection was required around the left main trunk （LMT）. A 62-year-old man who had coronary artery fistulae with an aneurysm which increased from 12 mm to 16 mm in a two-year span. The fistula was located adjacent to the LMT. A complete aneurysm excision under cardiopulmonary bypass was performed, which required pulmonary artery transection. No postoperative complications occurred. Postoperative coronary computed tomography scan showed intact coronary arteries and complete aneurysm removal.