大動脈弁置換術後数時間で判明した右冠状動脈狭窄の1例

Right Coronary Artery Stenosis Demonstrated a Few Hours After Surgical Aortic Valve Replacement：Report of a Case

はじめに　外科的大動脈弁置換術（SAVR）後の冠状動脈閉塞および狭窄は術後突然死の原因となりうるとされ，重大な合併症の一つである．われわれはSAVR後，数時間経過した後に判明した右冠状動脈（RCA）狭窄をきたした症例を経験したので報告する．

Some cases of coronary artery occlusion by prosthetic valves after surgical aortic valve replacement （SAVR） may be diagnosed and treated during operation if it is difficult to be separated from cardiopulmonary bypass. We present a case of a 74-year-old woman with symptomatic aortic stenosis due to bicuspid valve and a narrow aortic valve annulus. SAVR was considered to be feasible over transcatheter aortic valve implantation given her anatomy and frailty. A few hours after successful SAVR using a 19 mm bioprosthetic valve, she became hemodynamically unstable in the intensive care unit, and coronary angiography revealed severe stenosis at the right coronary artery orifice. Percutaneous coronary intervention was deemed technically demanding, and she subsequently underwent coronary artery bypass grafting. On the 35th postoperative day, the patient was transferred to another facility for rehabilitation. Two years after surgery, she has no chest symptoms and constantly visits the outpatient clinic by herself.