右側大動脈弓に合併した下行大動脈憩室の2治験例
症例1は70歳男性．既往に胆石症，左鼠径ヘルニアを有する．鼠径ヘルニア術前精査にて縦郭陰影の拡大を指摘され，当科紹介受診．精査にて右側大動脈弓，右側下行大動脈，憩室形態の下行大動脈と診断，手術加療の方針とした．自覚症状や心内奇形，他の心血管疾患は認めなかった．手術は右後側方第4肋間開胸，下半身部分体外循環にて憩室を含む下行大動脈置換術を予定した．しかし，中枢側遮断部の大動脈内膜損傷から低体温脳循環停止，open proximal法で中枢側吻合を行った．術後経過は問題なく，術後19病日に独歩退院．症例2は51歳女性．中国で出生し，15年前より日本に在住している．特記すべき既往症．健康診断にて施行...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 52; no. 1; pp. 41 - 45 |
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| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本心臓血管外科学会
15.01.2023
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.52.41 |
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| Abstract | 症例1は70歳男性．既往に胆石症，左鼠径ヘルニアを有する．鼠径ヘルニア術前精査にて縦郭陰影の拡大を指摘され，当科紹介受診．精査にて右側大動脈弓，右側下行大動脈，憩室形態の下行大動脈と診断，手術加療の方針とした．自覚症状や心内奇形，他の心血管疾患は認めなかった．手術は右後側方第4肋間開胸，下半身部分体外循環にて憩室を含む下行大動脈置換術を予定した．しかし，中枢側遮断部の大動脈内膜損傷から低体温脳循環停止，open proximal法で中枢側吻合を行った．術後経過は問題なく，術後19病日に独歩退院．症例2は51歳女性．中国で出生し，15年前より日本に在住している．特記すべき既往症．健康診断にて施行した胸部Xpにて異常陰影を指摘，胸部CTにて大動脈奇形が疑われ当科紹介受診．右側大動脈弓，右側下行大動脈，左鎖骨下動脈起始異常，Kommerell憩室の診断となった．自覚症状なく，心内奇形も認めなかった．手術は二期的手術の方針とした．初回手術として，胸骨正中切開で左鎖骨下動脈胸腔内再建を伴う全弓部置換術，オープンステントグラフト内挿術を行い，Kommerell憩室はオープンステントグラフトでカバーした．憩室そのものは背側に位置し，処理は行わなかった．術後15病日にKommerell憩室から左鎖骨下動脈起始部の塞栓術を行った．術後経過は問題なく，術後19病日独歩退院となった．右側大動脈弓に合併した下行大動脈憩室，Kommerell憩室は種々の手術方法が報告されている．文献的考察を加え報告する． |
|---|---|
| AbstractList | 症例1は70歳男性．既往に胆石症，左鼠径ヘルニアを有する．鼠径ヘルニア術前精査にて縦郭陰影の拡大を指摘され，当科紹介受診．精査にて右側大動脈弓，右側下行大動脈，憩室形態の下行大動脈と診断，手術加療の方針とした．自覚症状や心内奇形，他の心血管疾患は認めなかった．手術は右後側方第4肋間開胸，下半身部分体外循環にて憩室を含む下行大動脈置換術を予定した．しかし，中枢側遮断部の大動脈内膜損傷から低体温脳循環停止，open proximal法で中枢側吻合を行った．術後経過は問題なく，術後19病日に独歩退院．症例2は51歳女性．中国で出生し，15年前より日本に在住している．特記すべき既往症．健康診断にて施行した胸部Xpにて異常陰影を指摘，胸部CTにて大動脈奇形が疑われ当科紹介受診．右側大動脈弓，右側下行大動脈，左鎖骨下動脈起始異常，Kommerell憩室の診断となった．自覚症状なく，心内奇形も認めなかった．手術は二期的手術の方針とした．初回手術として，胸骨正中切開で左鎖骨下動脈胸腔内再建を伴う全弓部置換術，オープンステントグラフト内挿術を行い，Kommerell憩室はオープンステントグラフトでカバーした．憩室そのものは背側に位置し，処理は行わなかった．術後15病日にKommerell憩室から左鎖骨下動脈起始部の塞栓術を行った．術後経過は問題なく，術後19病日独歩退院となった．右側大動脈弓に合併した下行大動脈憩室，Kommerell憩室は種々の手術方法が報告されている．文献的考察を加え報告する． |
| Author | 宮原, 拓也 荻原, 正規 尾﨑, 公彦 西野, 純史 |
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| References | 4) Ogino H. JCS/JSCVS/JATS/JSVS 2020 guideline on diagnosis and treatment of aortic aneurysm and aortic dissection. 161-162. https://www.j-circ.or.jp/cms/wp-content/uploads/2020/07/JCS2020_Ogino.pdf : (accessed April 8, 2022 2) Knight L, Edwards JE. Right aortic arch types and associated cardiac anomalies. Circulation 1974; 50: 1047-51. 1) McElhinney DB, Hoydu AK, Gaynor JW et al. Patterns of right aortic arch and mirror-image branching of the brachiocephalic vessels without associated anomalies. Pediatr Cardiol 2001; 22: 285-91. 16) Nakanaga H, Morimura H, Hiraiwa N et al. Hybrid repair in a patient with Kommerell diverticulum and right aortic arch. Jpn J Cardiovasc Surg 2019; 48: 361-4. 14) Barr JG, Sepehripour AH, Jarral OA et al. A review of the surgical management of right-sides aortic arch aneurysm. Interact Cardiovasc Thorac Surg 2016; 23: 156-62. 10) Kim KM, Cambria RP, Isselbacher EM et al. Contemporary surgical approaches and outcomes in adults with Kommerell diverticulum. Ann Thorac Surg 2014; 98: 1347-54. 13) Backer CL, Mavroudis C, Rigsby CK et al. Trends in vascular ring surgery. J Thorac Cardiovasc Surg 2005; 129: 1339-47. 5) Austin EH, Wolfe WG. Aneurysm of aberrant subclavian artery with a review of the literature. J Vasc Surg 1985; 2: 571-7. 11) Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: a comprehensive review. Gen Thorac Cardiovasc Surg 2015; 63: 245-59. 18) Kanda H, Moriyama Y, Imoto Y et al. surgical treatment of Kommerell diverticulum and the aberrant subclavian artery: four case reports. Jpn J Cardiovasc Surg 2017; 46: 173-6. 6) Cina CS, Althani H, Pasenau J et al. Kommerell's diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg 2004; 39: 131-9. 8) Idrees J, Keshavamurthy S, Subramanian S et al. Hybrid repair of Kommerell diverticulum. J Thorac Cardiovasc Surg 2014; 147: 973-6. 15) Kamihira S, Yamauchi M, Kitano T et al. Debranching and endovascular repair for Kommerell's diverticulum involving right-sided aortic arch with mirror image branching. Jpn J Cardiovasc Surg 2014; 43: 322-5. 20) Kawasaki H, Nakayama Y, Koga Y et al. Surgical repair of Kommerell's diverticulum with right sided aortic arch. Kyobu Geka 2018; 71: 361-4. 7) Kouchoukos NT, Masetti P. Aberrant subclavian artery and Kommerell aneurysm: surgical treatment with a standard approach. J Thorac Cardiovasc Surg 2007; 133: 888-92. 12) Ota T, Okada K, Takanashi S et al. Surgical treatment for Kommerell's diverticulum. J Thorac Cardiovasc Surg 2006; 131: 574-8. 17) Kawashima T, Koga T, Hatanaka N et al. Debranching and endovascular repair for Kommerell's diverticulum with right-sided aortic arch. Kyobu Geka 2020; 73: 610-3. 3) Barr JG, Sepehripour AH, Jarral OA et al. A review of the surgical management of right-sided aortic arch aneurysms. Interact CardioVasc Thorac Surg 2016; 23: 156-62. 19) Harada S, Nakamura Y, Marumoto A et al. A surgical case of Kommerell's diverticulum with a right-sided aortic arch. Jpn J Cardiovasc Surg 2009; 38: 368-71. 9) Hayashi T, Ichikawa T, Yamamoto H et al. Right aortic arch with mirror-image branching in adults: evaluation using CT. Tokai J Exp Clin Med 2018; 43: 30-7. |
| References_xml | – reference: 15) Kamihira S, Yamauchi M, Kitano T et al. Debranching and endovascular repair for Kommerell's diverticulum involving right-sided aortic arch with mirror image branching. Jpn J Cardiovasc Surg 2014; 43: 322-5. – reference: 5) Austin EH, Wolfe WG. Aneurysm of aberrant subclavian artery with a review of the literature. J Vasc Surg 1985; 2: 571-7. – reference: 4) Ogino H. JCS/JSCVS/JATS/JSVS 2020 guideline on diagnosis and treatment of aortic aneurysm and aortic dissection. 161-162. https://www.j-circ.or.jp/cms/wp-content/uploads/2020/07/JCS2020_Ogino.pdf : (accessed April 8, 2022) – reference: 11) Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: a comprehensive review. Gen Thorac Cardiovasc Surg 2015; 63: 245-59. – reference: 13) Backer CL, Mavroudis C, Rigsby CK et al. Trends in vascular ring surgery. J Thorac Cardiovasc Surg 2005; 129: 1339-47. – reference: 17) Kawashima T, Koga T, Hatanaka N et al. Debranching and endovascular repair for Kommerell's diverticulum with right-sided aortic arch. Kyobu Geka 2020; 73: 610-3. – reference: 1) McElhinney DB, Hoydu AK, Gaynor JW et al. Patterns of right aortic arch and mirror-image branching of the brachiocephalic vessels without associated anomalies. Pediatr Cardiol 2001; 22: 285-91. – reference: 20) Kawasaki H, Nakayama Y, Koga Y et al. Surgical repair of Kommerell's diverticulum with right sided aortic arch. Kyobu Geka 2018; 71: 361-4. – reference: 2) Knight L, Edwards JE. Right aortic arch types and associated cardiac anomalies. Circulation 1974; 50: 1047-51. – reference: 8) Idrees J, Keshavamurthy S, Subramanian S et al. Hybrid repair of Kommerell diverticulum. J Thorac Cardiovasc Surg 2014; 147: 973-6. – reference: 10) Kim KM, Cambria RP, Isselbacher EM et al. Contemporary surgical approaches and outcomes in adults with Kommerell diverticulum. Ann Thorac Surg 2014; 98: 1347-54. – reference: 16) Nakanaga H, Morimura H, Hiraiwa N et al. Hybrid repair in a patient with Kommerell diverticulum and right aortic arch. Jpn J Cardiovasc Surg 2019; 48: 361-4. – reference: 14) Barr JG, Sepehripour AH, Jarral OA et al. A review of the surgical management of right-sides aortic arch aneurysm. Interact Cardiovasc Thorac Surg 2016; 23: 156-62. – reference: 9) Hayashi T, Ichikawa T, Yamamoto H et al. Right aortic arch with mirror-image branching in adults: evaluation using CT. Tokai J Exp Clin Med 2018; 43: 30-7. – reference: 3) Barr JG, Sepehripour AH, Jarral OA et al. A review of the surgical management of right-sided aortic arch aneurysms. Interact CardioVasc Thorac Surg 2016; 23: 156-62. – reference: 7) Kouchoukos NT, Masetti P. Aberrant subclavian artery and Kommerell aneurysm: surgical treatment with a standard approach. J Thorac Cardiovasc Surg 2007; 133: 888-92. – reference: 18) Kanda H, Moriyama Y, Imoto Y et al. surgical treatment of Kommerell diverticulum and the aberrant subclavian artery: four case reports. Jpn J Cardiovasc Surg 2017; 46: 173-6. – reference: 19) Harada S, Nakamura Y, Marumoto A et al. A surgical case of Kommerell's diverticulum with a right-sided aortic arch. Jpn J Cardiovasc Surg 2009; 38: 368-71. – reference: 6) Cina CS, Althani H, Pasenau J et al. Kommerell's diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg 2004; 39: 131-9. – reference: 12) Ota T, Okada K, Takanashi S et al. Surgical treatment for Kommerell's diverticulum. J Thorac Cardiovasc Surg 2006; 131: 574-8. |
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| SubjectTerms | Kommerell憩室 下行大動脈瘤 右側大動脈弓 鎖骨下動脈起始異常 |
| Title | 右側大動脈弓に合併した下行大動脈憩室の2治験例 |
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