Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 38(4): 249-253 (2022)
doi:10.9794/jspccs.38.249

症例報告Case Report

成人型ALCAPA患者の術後心不全を認めた1例:その原因についてPostoperative Heart Failure in a Teen with Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: A Case Report Regarding Mechanisms

1JCHO中京病院中京こどもハートセンター小児循環器科Department of Pediatric Cardiology, Chukyo Children Heart Center, Japan Community Health Care Organization Chukyo Hospital ◇ Aichi, Japan

2JCHO中京病院中京こどもハートセンター心臓血管外科Department of Cardiovascular Surgery, Chukyo Children Heart Center, Japan Community Health Care Organization Chukyo Hospital ◇ Aichi, Japan

受付日:2022年3月28日Received: March 28, 2022
受理日:2022年9月10日Accepted: September 10, 2022
発行日:2022年12月1日Published: December 1, 2022
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症例は16歳女児で,動悸や胸部絞扼感の訴えがあり前医を受診し,左冠動脈肺動脈起始症(Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: ALCAPA)の診断で当院に紹介となった.手術は竹内法を選択し特記すべき問題なく終了したが,術後より心機能低下と鬱血による呼吸不全を認めた.心不全治療目的にビソプロロールを貼付したところ症状の速やかな改善が得られ,鑑別目的にカテーテル検査を行ったところ冠血流の鬱滞と左右冠血流の上行大動脈への逆流を確認した.前医の造影CT検査を確認し直したところCS径が2.5 mmと平均と比較して1/2以下の低形成であったことも判明した.成人型ALCAPA症例の心機能低下について言及されている報告は少ないが,冠血流の鬱滞が主病態と思われること,鬱滞の一因としてCS低形成が関与していた可能性が示唆された.

A 16-year-old girl, who noted palpitations, and tightness in her chest, was referred to our hospital with a diagnosis of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). She underwent surgery using the Takeuchi method without difficulty, but she had respiratory distress and decreased cardiac function following surgery. Her symptoms improved rapidly after treatment with bisoprolol. Cardiac catheterization, performed to identify the cause of her symptoms, confirmed congestion of blood flow within the coronary vessels and regurgitation of right and left coronary blood flow into the ascending aorta. Although there are few reports discussing the cause of cardiac dysfunction in adults with ALCAPA, congestion of blood flow within the coronary vessels may cause postoperative cardiac dysfunction. Preoperative coronary sinus evaluation may identify a possible cause of postoperative cardiac dysfunction.

Key words: anomalous origin of the left coronary artery from the pulmonary artery; coronary sinus; preoperative diagnosis

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This page was last modified on 2023-02-21T18:37:38.000+09:00


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