島状再建による全弓部置換術後11年目に巨大な弓部吻合部仮性動脈瘤をきたし再手術を施行した1例
全弓部置換術後11年目にきたした巨大な弓部吻合部仮性動脈瘤に対して再手術を施行した稀な1例を経験した．症例は68歳男性．2003年（56歳）慢性大動脈解離に対して他院にて弓部3分枝島状再建による全弓部置換術が施行され，その後近医にてフォローアップされていた．特に症状はなかったが，長期間経過しておりCTを撮影したところ，81 mmの巨大な弓部吻合部仮性動脈瘤と大動脈基部拡張，冠動脈病変を指摘された．他院では手術困難であり，当院に紹介受診となった．右腋窩動脈・大腿動脈送血，大腿静脈脱血で体外循環確立し，選択的脳還流下に再全弓部置換＋大動脈基部置換＋冠動脈バイパス術を行った．術後一時期呼吸不全にて再...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 44; no. 4; pp. 232 - 236 |
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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
2015
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.44.232 |
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| Abstract | 全弓部置換術後11年目にきたした巨大な弓部吻合部仮性動脈瘤に対して再手術を施行した稀な1例を経験した．症例は68歳男性．2003年（56歳）慢性大動脈解離に対して他院にて弓部3分枝島状再建による全弓部置換術が施行され，その後近医にてフォローアップされていた．特に症状はなかったが，長期間経過しておりCTを撮影したところ，81 mmの巨大な弓部吻合部仮性動脈瘤と大動脈基部拡張，冠動脈病変を指摘された．他院では手術困難であり，当院に紹介受診となった．右腋窩動脈・大腿動脈送血，大腿静脈脱血で体外循環確立し，選択的脳還流下に再全弓部置換＋大動脈基部置換＋冠動脈バイパス術を行った．術後一時期呼吸不全にて再挿管を行ったが，その後の経過は良好で術後50日目に退院となった．本症例のような島状再建法を施行した場合には遠隔期に仮性瘤が発生する可能性があり，術後も厳重な観察が必要である．特に慢性解離症例では初回手術時に極力大動脈壁を残さないような再建方法を十分検討する必要がある． |
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| AbstractList | 全弓部置換術後11年目にきたした巨大な弓部吻合部仮性動脈瘤に対して再手術を施行した稀な1例を経験した．症例は68歳男性．2003年（56歳）慢性大動脈解離に対して他院にて弓部3分枝島状再建による全弓部置換術が施行され，その後近医にてフォローアップされていた．特に症状はなかったが，長期間経過しておりCTを撮影したところ，81 mmの巨大な弓部吻合部仮性動脈瘤と大動脈基部拡張，冠動脈病変を指摘された．他院では手術困難であり，当院に紹介受診となった．右腋窩動脈・大腿動脈送血，大腿静脈脱血で体外循環確立し，選択的脳還流下に再全弓部置換＋大動脈基部置換＋冠動脈バイパス術を行った．術後一時期呼吸不全にて再挿管を行ったが，その後の経過は良好で術後50日目に退院となった．本症例のような島状再建法を施行した場合には遠隔期に仮性瘤が発生する可能性があり，術後も厳重な観察が必要である．特に慢性解離症例では初回手術時に極力大動脈壁を残さないような再建方法を十分検討する必要がある． |
| Author | 田中, 健史 佐村, 高明 上仲, 永純 門田, 治 谷口, 智史 堤, 泰史 大橋, 博和 松浦, 良平 |
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| References | 5) Sasaki, A., Sakata, J., Satou, H. et al. : A case of descending graft replacement of the anastomotic aneurysm using simple hypothermic retrograde cerebral circulation 9 years after surgery of the distal aortic arch. Jpn. J. Cardiovasc. Surg. 31 : 311-313, 2002. 9) Sasaki, M., Usui, A., Yoshikawa, M. et al. : Arch-first technique performed under hypothermic circulatory arrest with retrograde cerebral perfusion improves neurological outcomes for total arch replacement. Eur. J. Cardiothorac. Surg. 27 : 821-825, 2005. 12) Katsumata, T., Moorjani, N., Vaccari, G. et al. : Mediastinal false aneurysm after thoracic aortic surgery. Ann. Thorac. Surg. 70 : 547-552, 2000. 6) Harrington, D.K., Bonser, M., Bonser, R.S. et al. : Neuropsychometric outcome following aortic arch surgery : a prospective randomized trial of retrograde cerebral perfusion. J. Thorac. Cardiovasc. Surg. 126 : 638-644, 2003. 11) Ohtake, H., Kimura, K., Yashiki, Y. et al. : T-graft technique under antegrade cerebral perfusion for aortic arch aneurysm. Ann. Thorac. Surg. 90 : 1721-1723, 2010. 1) Di Eusanio, M., Berretta, P., Cefarelli, M. et al. : Long-term outcomes after aortic arch surgery : results of a study involving 623 patients. Eur. J. Cardiothorac. Surg. pii : ezu468. Dec 2.2014. 2) Li, B., Ma, W.G., Liu, Y.M. et al. : Is extended arch replacement justified for acute type A aortic dissection?. Interact. Cardiovasc. Thorac. Surg. 20 : 120-126, 2015. 10) Ishida, N., Shimabukuro, K., Matsuno, Y. et al. : Ascending aorta and total arch replacement in a Stanford type A aortic dissection with island reconstruction for an isolated left vertebral artery. Jpn. J. Cardiovasc. Surg. 39 : 318-320, 2010. 13) Malvindi, P.G., van Putte, B.P., Heijmen, R.H. et al. : Reoperations for aortic false aneurysms after cardiac surgery. Ann. Thorac. Surg. 90 : 1437-1443, 2010. 7) Okita, Y., Minatoya, K., Tagusari, O. et al. : Prospective comparative study of brain protection in total aortic arch replacement : deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann. Thorac. Surg. 72 : 72-79, 2001. 8) Rokkas, C.K. and Kouchoukos, N.T. : Single-stage extensive replacement of the thoracic aorta : the arch-first technique. J. Thorac. Cardiovasc. Surg. 117 : 99-105, 1999. 14) Ikeda, O., Ideta, I., Kunitomo, R. et al. : Management of endovascular repair for anastomotic pseudoaneurysm after surgical reconstruction. Jpn. J. Vasc. Surg. 18 : 573-579, 2009. 15) Malvindi, P.G., van Putte, B.P., Sonker, U. et al. : Reoperation after acute type A aortic dissection repair : a series of 104 patients. Ann. Thorac. Surg. 95 : 922-927, 2013. 3) Kimura, S. and Ueno, Y. : Redo total arch replacement for a patient with pseudoaneurysm of the Thoracic Aortic Graft. Jpn. J. Cardiovasc. Surg. 41 : 29-32, 2012. 4) Izumiyama, O., Yamashita, A., Sugimoto, S. et al. : A case of anastomotic pseudoaneurysm at an anastomosis between two woven Dacron prostheses following aortic arch replacement. Jpn. J. Cardiovasc. Surg. 29 : 191-194, 2000. |
| References_xml | – reference: 9) Sasaki, M., Usui, A., Yoshikawa, M. et al. : Arch-first technique performed under hypothermic circulatory arrest with retrograde cerebral perfusion improves neurological outcomes for total arch replacement. Eur. J. Cardiothorac. Surg. 27 : 821-825, 2005. – reference: 8) Rokkas, C.K. and Kouchoukos, N.T. : Single-stage extensive replacement of the thoracic aorta : the arch-first technique. J. Thorac. Cardiovasc. Surg. 117 : 99-105, 1999. – reference: 10) Ishida, N., Shimabukuro, K., Matsuno, Y. et al. : Ascending aorta and total arch replacement in a Stanford type A aortic dissection with island reconstruction for an isolated left vertebral artery. Jpn. J. Cardiovasc. Surg. 39 : 318-320, 2010. – reference: 4) Izumiyama, O., Yamashita, A., Sugimoto, S. et al. : A case of anastomotic pseudoaneurysm at an anastomosis between two woven Dacron prostheses following aortic arch replacement. Jpn. J. Cardiovasc. Surg. 29 : 191-194, 2000. – reference: 5) Sasaki, A., Sakata, J., Satou, H. et al. : A case of descending graft replacement of the anastomotic aneurysm using simple hypothermic retrograde cerebral circulation 9 years after surgery of the distal aortic arch. Jpn. J. Cardiovasc. Surg. 31 : 311-313, 2002. – reference: 6) Harrington, D.K., Bonser, M., Bonser, R.S. et al. : Neuropsychometric outcome following aortic arch surgery : a prospective randomized trial of retrograde cerebral perfusion. J. Thorac. Cardiovasc. Surg. 126 : 638-644, 2003. – reference: 12) Katsumata, T., Moorjani, N., Vaccari, G. et al. : Mediastinal false aneurysm after thoracic aortic surgery. Ann. Thorac. Surg. 70 : 547-552, 2000. – reference: 3) Kimura, S. and Ueno, Y. : Redo total arch replacement for a patient with pseudoaneurysm of the Thoracic Aortic Graft. Jpn. J. Cardiovasc. Surg. 41 : 29-32, 2012. – reference: 7) Okita, Y., Minatoya, K., Tagusari, O. et al. : Prospective comparative study of brain protection in total aortic arch replacement : deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann. Thorac. Surg. 72 : 72-79, 2001. – reference: 14) Ikeda, O., Ideta, I., Kunitomo, R. et al. : Management of endovascular repair for anastomotic pseudoaneurysm after surgical reconstruction. Jpn. J. Vasc. Surg. 18 : 573-579, 2009. – reference: 1) Di Eusanio, M., Berretta, P., Cefarelli, M. et al. : Long-term outcomes after aortic arch surgery : results of a study involving 623 patients. Eur. J. Cardiothorac. Surg. pii : ezu468. Dec 2.2014. – reference: 13) Malvindi, P.G., van Putte, B.P., Heijmen, R.H. et al. : Reoperations for aortic false aneurysms after cardiac surgery. Ann. Thorac. Surg. 90 : 1437-1443, 2010. – reference: 2) Li, B., Ma, W.G., Liu, Y.M. et al. : Is extended arch replacement justified for acute type A aortic dissection?. Interact. Cardiovasc. Thorac. Surg. 20 : 120-126, 2015. – reference: 15) Malvindi, P.G., van Putte, B.P., Sonker, U. et al. : Reoperation after acute type A aortic dissection repair : a series of 104 patients. Ann. Thorac. Surg. 95 : 922-927, 2013. – reference: 11) Ohtake, H., Kimura, K., Yashiki, Y. et al. : T-graft technique under antegrade cerebral perfusion for aortic arch aneurysm. Ann. Thorac. Surg. 90 : 1721-1723, 2010. |
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| SubjectTerms | 再全弓部置換 島状再建 弓部吻合部仮性瘤 |
| Title | 島状再建による全弓部置換術後11年目に巨大な弓部吻合部仮性動脈瘤をきたし再手術を施行した1例 |
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