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Vol. 6 No. 1 2011 J Cardiol Jpn Ed 87
要 約
症例報告
急性大動脈解離に伴う血圧低下により冠血流障害をきたし,急性心筋梗塞を併発したと考えられた1例Acute Myocardial Infarction Due to Aortic Dissection; A Case Report of Coronary Malperfusion Caused by Hypotention Associated With Cardiac Tamponade
ところが,第37病日の日中,ベッド上でナースコール後に心肺停止状態となった.心臓超音波検査では大量の心囊液貯留を認め,心囊穿刺を実施したところ,血性心囊液が認められた(図7).同時に経皮的心肺補助装置(PCPS)を挿入した.緊急の冠動脈造影では,左前下行枝のステント留置部は問題なく,右冠動脈についても入院時と変化は認められなかった(図8).急性心筋梗塞後の心破裂再発と考え,緊急開胸手術の方針となった.しかし,手術準備中にPCPS管理下でも循環が保てなくなり,同日死亡確認した. 病理解剖を実施したところ,大動脈解離(Stanford分類 Type A)の所見が認められた.大動脈の偽腔内面の性状から,発症時期は死亡の約1カ月前,すなわち入院時であると推察さ
文 献Hirst AE, Jr., Johns VJ, Jr., Kime SW, Jr. Dissecting an-1) eurysm of the aorta: a review of 505 cases. Medicine (Baltimore) 1958; 37: 217–279.Luo JL, Wu CK, Lin YH, Kao HL, Lin MS, Ho YL, 2) Chen MF, Chao CL. Type A aortic dissection manifest-ing as acute myocardial infarction: still a lesson to learn. Acta Cardiol 2009; 64: 499–504.Kawahito K, Adachi H, Murata S, Yamaguchi A, Ino T. 3) Coronary malperfusion due to type A aortic dissection: mechanism and surgical management. Ann Thorac Surg 2003; 76: 1471–1476.Neri E, Toscano T, Papalia U, Frati G, Massetti M, Ca-4) pannini G, Tucci E, Buklas D, Muzzi L, Oricchio L, Sas-si C. Proximal aortic dissection with coronary malperfu-sion: presentation, management, and outcome. J Thorac Cardiovasc Surg 2001; 121: 552–560.池田勝哉.臓器虚血を伴う急性大動脈解離の外科治療法の5) 検討.胸部外科 1999; 52: 89–96.
Gu YL, Svilaas T, van der Horst IC, Zijlstra F. Condi-6) tions mimicking acute ST-segment elevation myocardial infarction in patients referred for primary percutaneous coronary intervention. Neth Heart J 2008; 16: 325–331.堀江 俊.解離性大動脈瘤の臨床病理学的検討 : とくに冠動7) 脈解離を中心に : 第 57 回日本循環器学会学術集会 : 動脈解離の病態と治療.Japanese circulation journal 1993; 57: 1283–1286.Zegers ES, Gehlmann HR, Verheugt FW. Acute myocar-8) dial infarction due to an acute type A aortic dissection involving the left main coronary artery. Neth Heart J 2007; 15: 263–264.Cardozo C, Riadh R, Mazen M. Acute myocardial in-9) farction due to left main compression aortic dissection treated by direct stenting. J Invasive Cardiol 2004;16: 89–91.Chan KC, Wu DJ, Ueng KC, Lin CS, Tsai CF, Chen KS, 10) Lin MC, Lin CS. Acute aortic dissection developing acute myocardial infarction diagnosed by accidentary inserting the catheters into the false lumen during cathe-terization: a pitfall and rare image. Jpn Heart J 2003; 44: 583–585.Bendjelid K, Fareh S, Bonnefoy E, Bohe J, Kirkorian G, 11) Touboul P, Fournier G. Acute dissection of the ascend-ing thoracic aorta complicated by myocardial infarct: an unavoidable diagnostic pitfall? Presse Med 2000; 29: 1220–1222.Forbes RA, Balderston G. Aortic dissection mimicking 12) acute myocardial infarction: the perils of prehospital care. Prehosp Emerg Care 2008; 12: 503–505.増山慎,松田光,添田健.今月の臨床 急性心筋梗塞を合併し13) た急性 A 型大動脈解離.胸部外科 2005; 58: 861–864.林和郎,樋口晃司,佐々木毅,櫻井馨,中村浩章,永田恭敏,14) 宮本貴庸,新田順一,尾林徹,丹羽明博,磯部光章,染谷毅,菅野隆彦,藤原等.大動脈解離が原因で急性心筋梗塞を発症したと思われる1 例.心臓 2003; 35: 753–759.Trabattoni P, Zoli S, Dainese L, Spirito R, Biglioli P, Ag-15) rifoglio M. Aortic dissection complicating intraaortic balloon pumping: percutaneous management of delayed spinal cord ischemia. Ann Thorac Surg 2009;88: e60–62.Masaki Y, Sumiyoshi M, Suwa S, Ohta H, Matsunaga E, 16) Tamura H, et al. Localized dissection of the sinus of val-salva without coronary artery involvement during percu-taneous coronary intervention. Int Heart J 2005; 46: 323–326.Colkesen AY, Baltali M, Tercan F. Concurrent dissec-17) tions of ascending aorta and right coronary artery dur-ing primary coronary angioplasty. Emerg Radiol 2007; 14: 249–251.