13年後に再手術を要したMCLSバイパス症例

A case report of redo A-C bypass for MCLS performed 13 year after initial surgery

　初回手術後13年目に再冠血行再建術を要した川崎病冠動脈後遺症症例を経験した。

　患者は，22歳，女性。6歳時に川崎病に罹患し，9歳時に狭心症状が出現したため大伏在静脈を用いて，左前下行枝（LAD），および右冠動脈（RCA）に冠血行再建術を施行。初回術後LADへのグラフトは閉塞したが，無症状に経過した。20歳時に狭心症状が再発し，冠動脈造影，心筋シンチ等の検査の結果，前壁，および側壁に虚血を認め，LADに左内胸動脈（LIMA），左LCXに胃大網動脈（GE）を用いた再手術適応と考えた。手術は，術中，LCXが確認できずLADへLIMAの1本バイパスのみとなったが，再手術後，狭心症状は消失し，術後心筋シンチで前壁の虚血は消失し，側壁の虚血も著明に改善し，術後経過は良好であった。川崎病冠動脈後遺症に対する再手術の報告は，検索し得た範囲で1例もなく若干の考察を加え，報告した。

This is the first report of reaortocoronary bypass for Kawasaki's disease. The patient is a 22-year old female. She was afflicted with Kawasaki's disease at the age of 6 and had the symptom of angina pectoris at the age of 9. She went through the first aortocoronary bypass, to the left anterior des-cending artery (LAD) and the right coronary ar-tery (RCA) with saphenous vein graft (SVG). After the first operation, the graft to LAD occluded total-ly, but she remained asymtomatic and well for 11 years. She had a sudden recurrence of anginal attack at the age of 20. The examinations confirmed ischemia of the anterior wall (LAD area) and the lateral wall (LCX area). Coronary angiography revealed patent SVG with a moderate sign of scle-rotic change. We decided on reaortocoronary by-pass, left mammary artery to LAD and gastroepiploic artery to LCX, when she was 22-years old. LIMA was anastomosed to LAD, but LCX was not revas-cularized, because LCX was not identified and ex-posed in the operation. In spite of incomplete revascularization, postoperative stress ECG test was negative. Tl-myocardial sintigram confirmed no ischemia of the anterior wall and greatly reduced ischemia in the lateral wall. She became asymtomatic and returnd to normal life.