術中冠状動脈造影検査が有用であった冠状動脈瘤の1例

A Useful Case of Coronary Angiography during Surgery for Coronary Aneurysms：Report of a Case

はじめに　冠状動脈瘻を伴う冠状動脈瘤は比較的まれな疾患であるが，その解剖は複雑であることが多く，手術のリスクとして冠状動脈本幹の損傷や不完全な病変の切除，冠状動脈瘻の残存などがあげられる．特に冠状動脈瘻の残存は瘤の再発や盗血現象など術後の遠隔成績に大きな影響を及ぼす可能性があるにもかかわらず，外科的治療介入後も19～30％と高率に発生している1）．これを回避すべく当科ではハイブリッド手術室で術中に冠状動脈造影検査を併用して手術を行っており，良好な成績を得ているため，その1手術例を報告する．

Coronary artery aneurysm with fistula is a relatively rare disease. After surgery, residual coronary fistula is often a problem. To prevent these problems, we perform coronary angiography during surgery, and have good grades. A 70-year-old-woman was admitted to our hospital with a chief complaint of palpitations. Enhanced computed tomography （CT） showed coronary aneurysms. Coronary angiography confirmed the coronary artery aneurysms with fistula to the pulmonary artery. Surgical intervention in the hybrid operating room was performed through median sternotomy with cardiopulmonary bypass. The fistulae were ligated, and the aneurysms were resected. Finally, coronary angiography was performed to confirm that there were no residual shunt aneurysm, or damage to the normal coronary artery, and the operation was completed. Postoperative course was uneventful, and she was discharged on postoperative day 19. Performing coronary angiography during surgery is very useful to confirm the aneurysms are completely closed, coronary artery fistulae are treated, and the coronary arteries are undamaged.