成人左冠状動脈肺動脈起始症に対し大伏在静脈を用いて大動脈-左冠状動脈主幹部を間置した1例

Main Trunk Interposition for Adult Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery Using a Great Saphenous Vein：Report of a Case

はじめに　左冠状動脈肺動脈起始症（ALCAPA）は肺動脈から左冠状動脈（LCA）が起始するまれな先天性心疾患であり，右冠状動脈（RCA）からLCAへの側副血行路により成人期まで無症状で経過することもある．LCAの低酸素飽和度や低血流により心筋虚血が起き，左室拡大や二次性の僧帽弁閉鎖不全を発症することがあり，その自然予後は不良である1）．われわれは成人ALCAPAに対し，大伏在静脈（SVG）を用いて大動脈-左冠状動脈主幹部（LMT）を間置した1例を経験した．

A 54-year-old woman was incidentally diagnosed with anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） during a pre-treatment screening computed tomography （CT） scan for alopecia areata. She had no cardiac symptoms, but cardiac magnetic resonance imaging （MRI） revealed late gadolinium enhancement （LGE） in the mid-anterior wall of the left ventricle, indicating myocardial ischemia. Median sternotomy was performed, with the left main trunk （LMT） was transected from the main pulmonary artery. Initially, reconstruction with an expanded polytetrafluoroethylene （ePTFE） graft was attempted, but the fragility of the vessel wall led to a change in strategy. A saphenous vein graft （SVG） was interposed between the aorta and LMT. The defect in the pulmonary artery was reconstructed with a bovine pericardial patch. Postoperative progress was favorable. Coronary CT during the one-year follow-up confirmed patency of the SVG and suggested regression of collateral circulation, indicating improved perfusion through the newly established graft.