家族性高脂血症合併の虚血性心疾患に対する手術

Surgery for ischemic heart disease secondary to familial hyperlipidemia

はじめに

　冠状動脈硬化症において高脂血症は重要な危険因子の1つである。また高脂血症は遺伝素因の下での発生が多いことが知られている。

　著者らはIIa型家族性高コレステロール血症，ヘテロ接合体患者で大動脈—冠動脈バイパス手術（coronaryartery bypass grafting，以下CABGと略す）後に狭心症が再発した54歳の男性に対して再手術を施行した。従来より家族性高性症血症合併の虚血性心疾患に対する外科治療の報告は数少なく，また本邦ではCABGに対する再手術の報告は未だ少ない。本諭文では，家族性高脂血症ならびに，CABGに対する再手術に関する問題点につき文献的考察を加えて報告したい。

The case of a 59-year-old patient suffering from coronary artery stenosis secondary to heterozygous familial hypercholesterolemia is reported. He under-went double coronary artery bypass grafting (LAD and RCA) for unstable angina pectoris two years ago, but one of the saphenous vein grafts (LAD) was occluded soon after the operation. As a result his anginal symptoms recurred and progressed grad-ually. He also had an ejection systolic murmur, Grade 1/6, over the aortic area and this murmur transmitted to the carotid vessels. Angiography show-ed that the aortic root was narrowed though cardi-ac catheterization disclosed no pressure gradient. Redo-operation with a new saphenous vein graft (LAD) was carried out, then his anginal symptoms was remarkably improved.

Although anginal symptoms could be ameliorated by successful surgical treatment, further evaluation is required as to whether the prognosis of this disease is affected by the surgery.