心マッサージ下の冠動脈インターベンション療法と低侵襲冠動脈バイパス術で救命，社会復帰しえた急性心筋梗塞の1例

Recovery due to the Emergency Coronary Interventions of Cardiac Massage and Less Invasive Coronary Artery Bypass Surgery in a Patient with Acute Myocardial Infarction

　症例は69歳，男性．1997年4月12日前胸部圧迫感，呼吸困難が出現し当科受診した．急性心筋梗塞と診断し緊急入院となった．入院直後心原性ショックとなり，直ちに気管内挿管を行い心カテーテル検査室へ搬送し，IABP挿入後冠動脈造影を行った．左冠動脈は左主幹部で完全閉塞，右冠動脈には近位部75％，中央部90％，遠位部99％狭窄がありTIMI grade2の灌流であった．冠動脈造影直後に心停止となり，心マッサージを行いながら右冠動脈3病変に対し4個のWiktorステントを連続的に挿入し，右冠動脈の再灌流を図ったところ心拍が再開した．ステント挿入後左前下行枝への側副血行を認めた．第14病日には非体外循環下で左前下行枝へ左内胸動脈を用いてバイパス術を施行した．その後，狭心症発作の出現なく第100病日に軽快退院し，社会復帰した．本例のごとき重症例でも救命のためには積極的に冠動脈インターベンションやバイパス術を行うべきと考えられた．

　A 69-year-old man was admitted to our hospital complaining of chest oppression and dyspnea on April 12, 1997. Electrocardiogram, blood examination and chest x-ray indicated that he was suffering from acute myocardial infarction and congestive heart failure. He entered cardiac shock immediately after admission and underwent cardiac catheterization with intra-aortic balloon pumping (IABP) and mechanical ventilatory support. The coronary angiogram showed total occlusion of the left main coronary artery with 75% stenosis at the proximal, 90% at mid and 99% at distal right coronary artery. Immediately after the coronary angiogram, he suffered cardiac arrest. He was treated by implantation of 4 stents to the right coronary artery lesions under cardiac massage until his heart beat was recovered. On the 14th hospital day, he underwent coronary artery bypass surgery without cardiopulmonary bypass, and the left internal thoracic artery was anastomosed to the distal left anterior descending artery. Angina attack disappeared after the operation, and he was discharged on the 100th hospital day. It was suggested that intensive therapies using coronary intervention and coronary artery bypass surgery should be tried even in such critical cases as this patient.