異型狭心症を合併した左冠動脈—肺動脈瘻の1症例

A case of coronary artery-pulmonary artery fistula associated with variant angina pectoris

　先天性冠動脈瘻は，比較的稀な疾患と考えられてきたが，冠動脈造影の普及によりその報告例も増加してきた。また，その中には虚血性心疾患を合併する例もあることが知られている。

　我々は，狭心症を有する51歳の男性に冠動脈造影を施行し，偶然，左冠動脈—肺動脈瘻を発見した。この症例の狭心痛は種々の検査にて冠spasm性の狭心症と診断され，冠動脈瘻による狭心痛とは考えられなかった。しかし，今後虚血性心疾患の増加に伴って，我々の症例のような冠動脈瘻もしばしば発見されると思われるので，文献的考察も加えて報告する。

A case of coronary artery fistula with variant angina pectoris was presented and referred to the review of literature. A 51 year old male was admit-ted to our hospital, complaining of chest pain. Elec-trocardiogram taken during spontaneous pain showed the elevation of ST segment in leads II, III and aVF. Not significant organic stenoses of the coronary artery but congenital coronary artery fistula between left anterior descending branch and pulmonary artery trunk were found by the coronary arteriog-raphy. After the right intracoronary administration of 25 itg-acetylcholine, chest pain occurred and the depression of ST segment was showed in leads II, III and aVF. Immediately, by selective coronary arteriography, severe spasm was found at the mid-portion in the right coronary artery. However, the left coronary artery did not respond to acetylcholine at all. This report is the first one on the congenital coronary artery fistula with variant angina. As the increase in patients with ischemic heart disease, the case of congenital coronary fistula complaining of chest pain which result from coronary artery spasm like this patient may be often found in future. This case suggested the importance of differential diagno-sis and the indication of operation to a case of coronary artery fistula with angina pectoris.