森 宏樹¹, 北出 和史¹, 守安 謙志¹, 物部 真子¹, 長谷部 愛¹, 有田 勝¹, 水谷 哲¹, 柏瀬 一路², 上田 恭敬², 榊 雅之³

Hiroki MORI¹, Kazushi KITADE¹, Kenji MORIYASU¹, Masako MONOBE¹, Ai HASEBE¹, Masaru ARITA¹, Tetsu MIZUTANI¹, Kazunori KASHIWASE², Yasunori UEDA², Masayuki SAKAKI³

¹大阪警察病院臨床検査科, ²大阪警察病院循環器内科, ³大阪警察病院心臓血管外科

¹Department of Clinical Laboratory, Osaka Police Hospital, ²Cardiovascular Division, Osaka Police Hospital, ³Division of Cardiovascular Surgery, Osaka Police Hospital

キーワード : coronary artery pseudoaneurysm, echocardiography, extravascular leakage, percutaneous coronary intervention

67歳，男性．2009年1月，他院に入院し，左冠動脈主幹部病変を伴う冠動脈2枝病変と診断された．その後，手術目的のため当院に紹介され，3月に冠動脈バイパス手術が施行された．紹介元に転院となり実施された冠動脈造影にて，吻合部直後の左冠動脈前下行枝に狭窄が認められたため，10月に経皮的冠動脈形成術が施行された．施術中に造影剤の血管外漏出を認め，バルーンによる穿孔が疑われたために手技を中止し，心嚢液の増加に注意しながら経過観察されていたが，心臓超音波検査で前室間溝に嚢胞状の腫瘤を認めたため，同日，再び当院に紹介された．入院翌日に実施した心臓超音波検査では，嚢胞状の腫瘤が50×44×32 mmであった．10月下旬には，57×47×70 mmと著明に増大し，破裂の危険も考えられたため，3日後開胸的冠動脈仮性動脈瘤遮断術が施行された．術後1年の心臓超音波検査では，瘤の消失が認められた．今回，経皮的冠動脈形成術中に発生した仮性冠動脈瘤を経験した．瘤の大きさを超音波検査で経時的に評価し，破裂の危険を回避することができた．

A 67-year-old man was diagnosed with severe coronary artery stenosis in the left main trunk and two vessels in January 2009. Coronary artery bypass graft surgery was performed. After surgery, coronary angiograms revealed a severe stenosis of the left anterior descending artery at the distal portion of the anastomosis site. Percutaneous coronary intervention (PCI) to the culprit lesion was performed. During the operation, extravascular leakage of contrast agent was observed, and perforation of the coronary artery due to ballooning was suspected. The patient was referred to our hospital. A cystic mass (size 50×44×32 mm) was shown on the anterior interventricular sulcus by echocardiography. At follow-up echocardiography 20 days after the first detection, the mass had markedly increased in size to 57×47×70 mm. The risk of rupture was high, so an operation for closure of the coronary artery pseudoaneurysm was performed. Echocardiography was performed 1 year after surgery, at which time the mass had disappeared. We experienced a coronary artery pseudoaneurysm with penetration of the coronary artery due to PCI. Echocardiography was useful for evaluating the size of the pseudoaneurysm over time, allowing us to avoid the risk of rupture.