PTCAを施行した川崎病既往の1例

PTCA for Kawasaki Disease:Case report

　川崎病による左冠動脈瘤近位部高度狭窄病変に対してPTCAを行い良好な結果を得た．症例は16歳，女性．4歳の時，川崎病に罹患治癒後無症状に経過，学校検診で心電図異常を指摘され，運動負荷心電図にて前壁誘導（V_3-5）でST低下を認めた．CAGでは左右冠動脈瘤，左冠動脈瘤近位部高度狭窄が認められた．²⁰¹Tl運動負荷心筋シンチグラフィーでは，負荷後左室前壁中隔領域が再分布像を呈した．狭窄部は限局性高度狭窄で，偏在性の淡い石灰化を有したが，PTCAでは比較的容易に拡張できた．一因として，狭窄部が瘤消退期の内膜増殖性組織修復機転よりはむしろ，かつての瘤入口部血流停滞に基づく血栓性狭窄によって形成されたため，形成術による変化をうけやすかった可能性が示唆された．

A 16-year-old high school girl was referred to ourdepartment for further examination of abnormal elec-trocardiogram. She sufferred fever due to Kawasaki disease contracted when she was 4 years old. Her stress electrocardiogram and Tl-201 stress scintigraphy showed anteroseptal myocardial ischemia. Coronary angiography showed bilateral coronary artery aneur-ysms and severe short-segmental stenosis in the prox-imal portion of the left coronary artery aneurysm.

We successfully performed PTCA for the latter lesion, which was lightly calcified, but was subject to plastic change by staged inflations of two different-sized balloon catheters.

This suggests that the stenosis of the lesion was due to thrombi (or reperfused after obstruction) rather than due to intimal proliferation.