右冠状動脈入口部血栓嵌頓に対して外科治療を行った1例

Surgery for Right Coronary Artery Ostium Thrombus Occlusion：Report of a Case

はじめに　慢性心房細動に続発する重篤な合併症である全身塞栓症に対して，患者背景，既往症や出血リスクに応じて抗凝固療法が推奨されている1）．われわれは，抗凝固療法の切り替え期間での塞栓症合併，しかも非常にまれな右冠状動脈入口部への血栓陥頓を経験した．急性心筋梗塞の治療に加えて，続発する塞栓症を回避する戦略として心停止下の血栓摘出を選択したので，文献的考察を含め報告する．

We experienced a rare thrombus occlusion at the orifice of the right coronary artery in a patient with chronic atrial fibrillation and a history of cancer treatment. The thrombus plugged the right coronary artery, orifice accompanying protrusion into the aorta. There was a risk of a systemic embolism if it scattered. By utilizing computed tomography （CT） scan, we were able to avoid subsequent systemic embolism and make the diagnosis. We selected thrombectomy by open heart surgery to avoid subsequent embolism. We report this case with a review of the literature.