巨大瘤化した無症候性冠状動脈瘻の1例

Successful Open Surgical Repair of Asymptomatic Coronary Artery Fistula with Giant Aneurysm：Report of a Case

はじめに　冠状動脈瘻の病因の大部分は先天性異常が占め，冠状動脈造影，冠状動脈CTの普及により診断例が増えてきている．無症状例も多く存在するが，その管理法，治療法は明らかではない．われわれは，胸部X線異常で発見された無症状で巨大な瘤化を認めた冠状動脈瘻の1例を経験し，外科的治療により良好な結果が得られたので，文献的考察を加え報告する．

Coronary artery fistula is an uncommon congenital anomaly of the coronary arteries, and there are lots of variations. We present a-46-year-old male patient with abnormal cardiac silhouette on chest X-ray. Coronary computed tomography （CT） angiography showed coronary artery （left anterior descending artery）-to-pulmonary artery fistula with a giant aneurysm （55 mm）. Considering the risk of rupture, surgery was indicated. The patient underwent surgical repair through median sternotomy under cardiopulmorary bypass and cardiac arrest antegrade myocardial protection. Fistulas were dissected and ligated proximally and distally, then the aneuysm was resected. By flushing bloody cardioplegic solution, we confirmed that there was no residual blood inflow to the aneurysm. Post-operative course was unevenful without evidence of myocardial injury. The patient discharged home on 10th postoperative day.