完全内臓逆位患者に対する緊急心拍動下冠状動脈バイパス術の1例

Emergent Off-pump Coronary Artery Bypass Grafting in a Patient with Situs Inversus Totalis：Report of a Case

はじめに　完全内臓逆位（situs inversus totalis）に伴う鏡像的右胸心（mirror-image dextrocardia）は比較的まれな疾患である．合併奇形も少なく，予後や冠状動脈疾患の頻度は健常者とかわらないとされている1）．

Dextrocardia associated with situs inversus totalis is a rare congenital anomaly. We herein report a patient with this condition and ischemic coronay artery disease who underwent emergency surgical myocardial revascularization. A 76-year-old man was admitted to our hospital with a diagnosis of unstable angina pectoris. He had incessant ventricular fibrillation attack on the second day of hospitalization. Emergent coronary angiography revealed total obstruction of the anatomically left anterior descending and right coronary arteries, and severe stenosis in the anatomically left circumflex artery. Emergent off-pump coronary artery bypass using saphenous vein grafts was successfully performed. Intraoperatively, the main surgeon continuouly stood on the patient’s right side except during anastosiso of a vein graft to the left circumflex artery. Postoperative course was almost uneventful aside from transient renal replacement and prolonged ventilation.