大動脈壁内走行を伴う右冠状動脈起始異常を合併した大動脈弁狭窄症と冠状動脈狭窄症の1例

Anomalous Origin of Right Coronary Artery with Intramural Course, Aortic Valve Stenosis and Coronary Artery Stenosis：Report of a Case

はじめに　先天性冠状動脈異常は比較的まれな疾患であり，一部を除き，その臨床的意義も少ないとされてきた．しかし，冠状動脈造影の普及により冠状動脈異常が頻繁に診断されるようになり，臨床的意義が再評価されるようになってきた．われわれは，術前に冠状動脈の起始走行異常を診断し，大動脈弁狭窄症（AS）に対する大動脈弁置換術（AVR）を行うとともに，虚血を懸念し冠状動脈バイパス術（CABG）を施行した1例を経験したので，文献的考察を加えて報告する．

Anomalous origin of the coronary artery is a rare congenital malformation that can cause myocardial ischemia and arrhythmia in patients with or without atherosclerotic lesions. We present a case of aortic stenosis （AS） and coronary artery stenosis complicated by anomalous origin of the right coronary artery （RCA） from the aortic valve sinus and its intramural course. The patient was a 66-year-old woman who was diagnosed with AS 4 years prior, and scheduled for surgery owing to gradual progression of stenosis. Preoperative coronary angiography revealed an abnormal origin of the RCA, and during the surgery, the RCA was found located within the aortic wall close to the aortotomy. Thus, bypass surgery was performed using a great saphenous vein, to prevent ischemia of the RCA territory. The patient had good intraoperative and postoperative course, and a coronary computed tomography scan clearly showed the reconstructed RCA.