右房瘻を伴う巨大右冠動脈瘤の 1 例を経験したので報告する.50 歳男性.動悸を主訴に近医を受診し,上室 性期外収縮の精査目的で当院に紹介された.CT にて右冠動脈入口部から右房後壁に至る巨大右冠動脈瘤 (ϕ22 mm)および冠動脈瘤-右房瘻を認めた.右冠動脈入口部のパッチ閉鎖,冠動脈瘤-右房瘻閉鎖,冠動脈 バイパス術(上行大動脈-橈骨動脈-右冠動脈) ,三尖弁形成術(Duran ring 29 mm)を施行した.術後経過 は良好で,第 19 病日に退院となった.術後 2 年が経過し問題なく外来経過観察中である.冠動脈瘤右房瘻 を認めた比較的稀な巨大冠動脈瘤に対する手術治療を経験したので,文献的報告を加えて報告する.日心外 会誌 43 巻 4 号:234-237(2014) キーワード:冠動脈瘤;冠状動脈右房瘻;冠動脈バイパス術 We describe successful surgical treatment of a right coronary artery aneurysm associated with a fistula to the right atrium(RA).

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... he patient was a 50-year-old man who complained of palpitations. ECG showed supraventricular extrasystole, and coronary CT revealed a remarkably dilated and undulating fistulous tract originating from the region corresponding to the orifice of the normal right coronary artery(RCA). The fistulous tract detoured to the posterior wall of the RA. An RCA of normal size originating from the midway of the fistulous tract was observed. The patient was operated on under cardio-pulmonary bypass. An aortocoronary bypass was performed, using a radial artery graft to section of the RCA that had a normal diameter. The RCA was subsequently ligated at the proximal side of the anastomosis. The orifice of the fistulous tract from the aorta was closed with a patch, and the entrance to the RA was also closed with mattress sutures. The postoperative recovery was uneventful, and he was discharged on the 19th postoperative day. Currently, the patient has been doing well without any complaints at 2 years postoperatively. Jpn. J. Cardiovasc. Surg. 43 : 234-237(2014) Keywords:right coronary artery to right atrium fistula ; congenital coronary artery fistula ; CABG Corresponding author : Ryota Nomura 〒 420-8630 静岡市追手町 10-93 本研究において一切の利益相反や研究資金の提供はない. None of the authors of this manuscript has any financial or personal relationship with other people or organizations that could inappropriately influence their work.