冠状動脈主幹部の巨大冠状動脈瘤

Giant Coronary Artery Aneurysm in the Main Trunk of the Coronary Artery

20 mmを超える巨大冠状動脈瘤はまれな疾患である．その発生由来は右冠状動脈がもっとも多く，次に左前下行枝（LAD）の頻度が高い1）と報告されているが左主幹部（LMT）由来の冠状動脈瘤の報告は非常にまれである．本稿では6 cmを超えたLMT由来の巨大冠状動脈瘤について，その場所ゆえに治療に工夫を要した手術症例を経験したので報告する．

The case is a 76-year-old woman. She was admitted to the hospital because of chest and back pain. Coronary angiography revealed a 62-mm giant coronary artery aneurysm originating from the left main trunk （LMT）, and urgent surgery was performed. Coronary artery-pulmonary artery fistula along with coronary artery aneurysm was completely removed by surgery. In this case, the reconstruction strategy for the LMT was crucial. The aneurysm wall was completely resected, allowing the coronary artery to return to its original course, and the length of the LMT defect was ＜2 cm. We determined that anatomical reconstruction of the LMT was optimal and succeeded in replacing a short great saphenous vein corresponding to the length of the defect. The patient was discharged without any complications.