1 和歌山県立医科大学第一外科The First Department of Surgery, Wakayama Medical University ◇ Wakayama, Japan
2 和歌山県立医科大学小児科Department of Pediatrics, Wakayama Medical University ◇ Wakayama, Japan
冠動脈瘻の頻度は低く，両側冠動脈が関与血管となるものは非常に稀である．今回，心雑音を主訴とした無症候性冠動脈瘻の4歳男児に対し冠動脈瘻閉鎖術を施行した．冠動脈瘻は小児期は無症状で経過することが多いが，成人期以降で心不全や狭心症状が生じるため，早期治療が望まれる．治療適応は，症状の有無や瘻孔血管の瘤化，瘻孔の大きさ等をもとに決定される．また，瘻孔の閉鎖方法には様々な術式が報告されているが，本症例では瘻孔血管の心筋壁内走行を認め，術前および術中所見から右室切開による直接瘻孔閉鎖法を選択した．
Coronary artery fistula (CAF) is a rare congenital anomaly, and a bilateral coronary artery origin is especially rare. We report the case of a 4-year-old boy who was diagnosed with a heart murmur without symptoms at 7 months of age. He underwent CAF closure via right ventriculotomy. Most cases of CAF are clinically asymptomatic in young patients. The CAF treatment strategy is determined by the symptoms, properties of the aneurysmal vessel, and the size of the fistula. As heart failure and exertional angina gradually appear in adulthood, treatment may be required earlier after diagnosis, depending on the patient’s condition. Various surgical options for closing the fistula have been reported; however, we selected right ventriculotomy in this case because of myocardial bridging of the fistula coronary arteries.
Key words: coronary artery fistula; myocardial bridging; coronary arterial aneurysmal change; right ventriculotomy
© 2016 特定非営利活動法人日本小児循環器学会© 2016 Japanese Society of Pediatric Cardiology and Cardiac Surgery
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This page was last modified on 2016-05-24T16:18:37.10+09:00
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