冠血行再建に低侵襲冠状動脈バイパス術を用いた大理石骨病の1例

Minimally Invasive Direct Coronary Artery Bypass in a Patient with Osteopetrosis and Symptomatic Ischemic Heart Disease：Report of a Case

はじめに　大理石骨病は，破骨細胞機能の欠陥によって骨吸収の欠陥をもたらす疾患である．骨密度の増加にもかかわらず，骨折の発生率が増加するうえに，骨折治癒も不良である．それゆえ胸骨正中切開のリスクが高いといわれている．

Osteopetrosis is a heterogeneous group of heritable conditions. It varies greatly in severity, and fracture treatment remains a matter of controversy due to altered responses to fixation and the risk of osteomyelitis. Therefore, sternotomy outcomes in this condition are unclear. We report the case of a patient with osteopetrosis and coronary artery disease （CAD）. A 78-year-old man with osteopetrosis presented with frequent chest pain. Coronary angiography revealed two-vessel CAD. Percutaneous coronary intervention was contraindication because of coronary aneurysm in the left main trunk. Considering risks in median sternotomy, we performed minimally invasive cardiac surgery through left minithoracotomy for coronary artery bypass grafting （CABG）. But we needed to break the left fourth rib to obtain sufficient surgical views. To the best of our knowledge, this is the first case report on CABG for a patient with osteopetrosis and endoscopic surgery without rib retractor is recommended.