症例は 58 歳の男性．断続する胸痛が出現し，不安定狭心症の診断で入院．冠動脈造影で左回旋枝と右冠動脈にそれぞれ 90%狭窄を認めた．抗血小板薬の内服およびへパリン・硝酸薬の持続点滴で経過観察後，左回旋枝に対し経皮的冠動脈形成術を行った．病変はびまん性で薬剤溶出性ステントを 2 本留置した．2 本目のステントを留置した直後より冠動脈内に血栓が出現した．血管内超音波上ステント malapposition は無く，血小板数の低下も認めなかった．ACT を 250 秒以上に保ち，繰り返しステント内拡張術を行ったが，その都度血栓が出現した．そこで，アルガトロバンを投与したところ，血栓が消失した．ヘパリン起因性血小板減少症を示唆する所見は無かったが，臨床的にアルガトロバンが有効であった．

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We here report a case of 28-year-old woman who received a percutaneous cardiopulmonary support(PCPS) under the diagnosis of fulminant myocarditis. She developed hematuria and hemolytic anemia due to failed drainage in the PCPS. After the exchange of the drainage tube to a larger size and simultaneous use of continuous hemodiafiltration, her cardiac function gradually improved. She discharged by walk from the hospital without complications 41 days after admission. Institution of PCPS secured by a sufficient flow with prevention of the complication could contribute to a full recovery in this patient with fulminant myocarditis.

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A 76-year-old man presented to our hospital with chest pain and dyspnea. Coronary angiography revealed a 90% stenosis in the left main trunk, 90% stenosis in the left circumflex artery, and total occlusion in the right coronary artery. He was also diagnosed as having severe renal dysfunction with serum Cr 3.93mg/dl, eGFR 12.5ml/min/1.73m² and Ccr 19.3ml/min. He underwent OPCAB, and carperitide was administered during the operation and continued until the 8 POD. The combined therapy of OPCAB and carperitide infusion were effective for protection of renal function during and after the operation. The urine output and renal function were maintained at the same level as the pre-operation values during and after the operation.

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