特発性冠動脈解離を発症した妊婦への帝王切開の周術期管理

Cesarean Section in a Pregnant Woman with Spontaneous Coronary Artery Dissection

要旨

　特発性冠動脈解離（spontaneous coronary artery dissection：SCAD）は女性に多く発症し，周産期の急性心筋梗塞の原因の1つとなる。われわれは妊娠22週でSCADを発症し，保存的治療中に陣痛発来により脊髄くも膜下麻酔による緊急帝王切開を要した症例を経験した。SCADを発症した妊婦では，循環動態を注視したうえでの区域麻酔による分娩が望ましいと考える。

　Spontaneous coronary artery dissection（SCAD）occurs more frequently in women than men and is one of the causes of acute myocardial infarction during the perinatal period. We treated a 26-year-old patient who exhibited SCAD that developed at 22 weeks of gestation. She was managed conservatively；however, due to the onset of labor, an emergency cesarean section was required. The patient delivered a healthy newborn under spinal subarachnoid anesthesia. In pregnant women with SCAD, planned regional anesthesia for the delivery is recommended, whenever possible.