冠動脈血栓と心筋梗塞の関係について

形態学的研究

抄録

Concerning the histogenesis of myocardial infarction, the “mechanical obstruction theory Virchow” was established and is inavoidably believed even now. And moreover, coronary thrombosis is regarded to be one of the most important primary causes of this disease. Based on this classical theory, some following peculiar findings most of which were never pointed out and emphasized can not be explained; such as (1) the existence of a prefered localization of a main coronary thrombus (about 2.5 to 5.0cm distal from the coronary ostium) and of “mechanical destruction accompanied by plasma inbibition” in the portion where a main thrombus attaches, (2) similar lesions in that portion in non-occulusive small thrombus cases and non-occulusive non-thrombotic (pre-thrombotic lesion YAJIMA & KOMOTO), (3) “Dysorie” lesions of systemic intramyocardial coronary arteries and arterioles in a necrotic area and its adjacent portions, being suspectedly regarded as to be due to a sudden elevation of inner pressure caused by arterial hemodynamic disorder, (4) surviving of fibers or of even a single fiber of the muscle cell in a myocardial necrotic part. A new “coronary dysfunction theory YAJIMA” may have to be introduced to explain consistently these peculiar findings in acute death cases due to myocardial infarction.
Detailed demonstrations of each of these findings being apparently contradictory to the classical theory were done and discussed in detail.
According to this theory, the dis-hemodynamic factor may be again seriously emphasized in addition to the coagulability of the blood, concerning the histogenesis of thrombosis.
It was additionally stated that similar arterial and arteriolar lesions could be observed in cases of cerebral and renal infarction diseases. Peculiarity of extramyocardial arterio- and/or athero-sclerosis of the coronary artery was stated, as the most important indirect supporting evidence of the “coronary disfunction theory”.