Kumano Hiroshi, Yamaguchi Akimitsu, Shuntoh Keisuke
Department of Cardiovascular Surgery, Northern Okinawa Cardiovascular Center, Nago, Japan.
Kyobu Geka. 2018 Nov;71(12):1040-1043.
A 45-year-old woman was admitted to our hospital because of chest pain on exertion. She was diagnosed to have an anomalous aortic origin of the right coronary artery(RCA) arising from the left sinus of Valsalva, passing between the aorta and the main pulmonary artery. Exercise treadmill test demonstrated significant depression of ST segments in leads II, III and aVF.Because medical treatment was ineffective, reimplantation of the RCA was performed. Dysfunction of the reimplanted RCA occurred, however 3 hours after surgery, and emergency coronary artery bypass grafting was performed using a saphenous vein graft to the RCA. After the 2nd operation, postoperative course was uneventful and multidetector row computed tomographic angiography revealed the patent vein graft and narrowing of the relocated site of RCA.
一名45岁女性因劳力性胸痛入院。她被诊断为右冠状动脉（RCA）起源异常，起自左冠窦，走行于主动脉和主肺动脉之间。运动平板试验显示Ⅱ、Ⅲ和aVF导联ST段明显压低。由于药物治疗无效，遂行RCA再植入术。然而，术后3小时再植入的RCA出现功能障碍，于是使用大隐静脉移植物对RCA进行了急诊冠状动脉旁路移植术。第二次手术后，术后过程顺利，多排螺旋CT血管造影显示静脉移植物通畅，RCA重新定位处狭窄。
