冠状動脈肺動脈瘻を伴う20 mmの冠状動脈瘤破裂の1例

Ruptured Saccular Small Coronary Artery Aneurysm Associated with a Coronary-pulmonary Artery Fistula：Report of a Case

はじめに　冠状動脈瘻（CAF）に合併する冠状動脈瘤破裂の報告はみられるが，瘤径30 mm以下で破裂した報告は少ない．われわれは，瘤径20 mmで破裂し外科的切除術を施行した症例を経験したので，文献的考察を加えて報告する．

The patient was an 86-year-old woman. She was brought to the emergency department because of chest pain and respiratory distress symptoms that did not improve. 12-lead electrocardiogram, echocardiography, and blood tests were negative for acute coronary syndrome, but a chest contrast computed tomography （CT） -scan showed pericardial effusion and a coronary artery aneurysm 20 mm in diameter, and punctured pericardial effusion revealed bloody fluid. A cardiac catheterization was performed. He underwent emergent surgery after being diagnosed as having a ruptured coronary aneurysm associated with a coronary pulmonary artery fistula. The aneurysm was dissected using cardiopulmonary bypass, and the coronary artery-pulmonary artery fistula was closed. The patient had a good postoperative course and was discharged in good condition. There have been few reports of rupture when the aneurysm diameter is less than 30 mm. Regardless of the size of the aneurysm, it has a risk of rupture and it is important to consider surgery.