器質的冠動脈病変を伴なう冠攣縮性狭心症に対してA-C bypass術を施行した1例—冠攣縮性狭心症におけるA-C bypass術の意義

Successful A-C bypass operation in patient with vasospaslic angina: evaluation with coronary circulation during attack

　近年，器質的冠動脈狭窄に対するA-C bypass術が確立されるにつれ，スパズムを伴なう冠動脈狭窄に対するA-C bypass術の適応が検討されはじめている。

　Pasternak^1），Shubrooks^2）らは良好な手術成績を報告している一方で，Bodenheimer^3），McAlpin^4）らは内科的治療に比べ著しく成績が劣ると報告しており，その評価はさまざまである。

A patient with ST-T segment elevation in chest leads of EC'G during anginal attack became asymp-tomatic after a 90% left anterior descending coronary artery (LAD) stenosis was bypassed.

Pre- and post-operation, ergonovine maleate (EM) was provocated for investigation of angina from the view points of coronary angiography, coronary hemodynamics and myocardial me-tabolism.

In pre-operative study, EM induced ST-T ele-vation in chest leads associated with chest pain, and coronary angiography showed coronary arterial spasm at the fixed lesion of LAD.

Coronary vascular resistance, lactate extraction ratio and cardiac output were decreased and pulmonary arterial end diastolic pressure was increased by EM. Angiographically, good patency of graft and peripheral perfusion of LAD were shown instead of remaining coronary arterial spasm at the same portion. No remarkable change was presented in coronary hemodynamics and myo-cardial metabolism.

we conclude that aorto-coronary bypass surgery is effective for the patients with vasospastic angina associated with coronary arterial stenosis not only from the view point of coronary angiography but coronary hemodynamics and myocardial metabo-lism.