成人先天性心疾患における大動脈基部拡大および上行弓部大動脈瘤の経験
〔背景〕成人先天性心疾患（ACHD）の増加に伴い，ACHDを有する胸部大動脈瘤症例（TAA）が増加している．当院での10年の症例を検討した．〔対象〕2002年から2011年まで，当科で施行したACHDを有するTAAの15例．〔結果〕男性13名，女性2名，再手術時年齢33.3±10.8歳．先天性心疾患は，TOF 5例，congenital AS 4例，VSD 3例，CoA complex 1例，poly/DORV 1例，poly/corrected TGA 1例．大動脈基部拡大12例，上行大動脈瘤3例，ARの合併を10例に認めた．13例は待機的手術，2例が緊急手術で，II型急性大動脈解離およびK...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 43; no. 5; pp. 254 - 259 |
|---|---|
| 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
2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.43.254 |
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| Abstract | 〔背景〕成人先天性心疾患（ACHD）の増加に伴い，ACHDを有する胸部大動脈瘤症例（TAA）が増加している．当院での10年の症例を検討した．〔対象〕2002年から2011年まで，当科で施行したACHDを有するTAAの15例．〔結果〕男性13名，女性2名，再手術時年齢33.3±10.8歳．先天性心疾患は，TOF 5例，congenital AS 4例，VSD 3例，CoA complex 1例，poly/DORV 1例，poly/corrected TGA 1例．大動脈基部拡大12例，上行大動脈瘤3例，ARの合併を10例に認めた．13例は待機的手術，2例が緊急手術で，II型急性大動脈解離およびKonno patchが離脱した症例であった．術式はBentall手術（＋部分弓部置換術）13例，上行大動脈置換＋AVR 1例，上行/部分弓部大動脈置換1例であった．手術時間572.8±101.4分，人工心肺時間295.8±100.2分，大動脈遮断時間188.1±58.8分．術後30日以内の死亡は認めなかった．MRSA敗血症による病院死亡を1例に認めたがその他の症例は全例が軽快退院，ICU滞在日数9.4±10.1日，在院日数34.4±18.2日であった．〔結語〕ACHDを有するTAA症例ではTOFが最多であった．ACHDを有するTAA症例の手術成績は良好であった． |
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| AbstractList | 〔背景〕成人先天性心疾患（ACHD）の増加に伴い，ACHDを有する胸部大動脈瘤症例（TAA）が増加している．当院での10年の症例を検討した．〔対象〕2002年から2011年まで，当科で施行したACHDを有するTAAの15例．〔結果〕男性13名，女性2名，再手術時年齢33.3±10.8歳．先天性心疾患は，TOF 5例，congenital AS 4例，VSD 3例，CoA complex 1例，poly/DORV 1例，poly/corrected TGA 1例．大動脈基部拡大12例，上行大動脈瘤3例，ARの合併を10例に認めた．13例は待機的手術，2例が緊急手術で，II型急性大動脈解離およびKonno patchが離脱した症例であった．術式はBentall手術（＋部分弓部置換術）13例，上行大動脈置換＋AVR 1例，上行/部分弓部大動脈置換1例であった．手術時間572.8±101.4分，人工心肺時間295.8±100.2分，大動脈遮断時間188.1±58.8分．術後30日以内の死亡は認めなかった．MRSA敗血症による病院死亡を1例に認めたがその他の症例は全例が軽快退院，ICU滞在日数9.4±10.1日，在院日数34.4±18.2日であった．〔結語〕ACHDを有するTAA症例ではTOFが最多であった．ACHDを有するTAA症例の手術成績は良好であった． |
| Author | 新垣, 正美 冨岡, 秀行 斎藤, 聡 山崎, 健二 青見, 茂之 石井, 光 東, 隆 笹生, 正樹 大森, 一史 遊佐, 裕明 |
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| References_xml | – reference: 15) Nagy, C.D., Alejo, D.E., Corretti, M.C. et al. : Tetralogy of Fallot and aortic root dilation : a long-term outlook. Pediatr. Cardiol. 34 : 809-816, 2013. – reference: 10) Pizarro, C., Baffa, J.M., Derby, C.D. et al. : Valve-sparing neo-aortic root replacement after Fontan completion for hypoplastic left heart syndrome. J. Thorac. Cardiovasc. Surg. 141 : 1083-1084, 2011. – reference: 4) Stulak, J.M., Dearani, J.A., Burkhart, H.M. et al. : Does the dilated ascending aorta in an adult with congenital heart disease require intervention?. J. Thorac. Cardiovasc. Surg. 140 : S52-57, 2010. – reference: 19) Piccardo, A., Ghez, O., Gariboldi, V. et al. : Ross and Ross-Konno procedures in infants, children and adolescents : a 13-year experience. J. Heart Valve Dis. 18 : 76-82, 2009. – reference: 9) Cleuziou, J., Mayr, N., Schreiber, C. et al. : Giant aortic aneurysm 18 years after repair of double-outlet right ventricle with pulmonary stenosis. Ann. Thorac. Surg. 82 : e31-2, 2006. – reference: 2) Chue, C.D., Hudsmith, L.E., Stumper, O. et al. : Femoral vascular access complications in adult congenital heart disease patients : audit from a single tertiary center. Congenit. Heart Dis. 3 : 336-340, 2008. – reference: 11) Shuhaiber, J.H., Patel, V., Husayni, T. et al. : Repair of symptomatic neoaortic aneurysm after third-stage palliation for hypoplastic left heart syndrome. J. Thorac. Cardiovasc. Surg. 131 : 478-479, 2006. – reference: 5) Hayashi, Y., Cochrane, A.D., Menahem, S. et al. : Neoaortic root dilatation with saccular aneurysm formation after the arterial switch operation for Taussig-Bing anomaly. J. Thorac. Cardiovasc. Surg. 133 : 569-572, 2007. – reference: 7) Murakami, T., Nakazawa, M., Momma, K. et al. : Impaired distensibility of neoaorta after arterial switch procedure. Ann. Thorac. Surg. 70 : 1907-1910, 2000. – reference: 16) Ishizaka, T., Ichikawa, H., Sawa, Y. et al. : Prevalence and optimal management strategy for aortic regurgitation in tetralogy of Fallot. Eur. J. Cardiothorac. Surg. 26 : 1080-1086, 2004. – reference: 18) Valeske, K., Müller, M., Hijjeh, N. et al. : The fate of the pulmonary autograft in the aortic position : experience and results of 98 patients in twelve years. Thorac. Cardiovasc. Surg. 58 : 334-338, 2010. – reference: 1) Shiina, Y., Toyoda, T., Kawasoe, Y. et al. : Prevalence of adult patients with congenital heart disease in Japan. Int. J. Cardiol. 146 : 13-16, 2011. – reference: 20) Koyak, Z., Harris, L., de Groot, J.R. et al. : Sudden cardiac death in adult congenital heart disease. Circulation 126 : 1944-1954, 2012. – reference: 14) Tan, J.L., Gatzoulis, M.A. and Ho, S.Y. : Aortic root disease in tetralogy of Fallot. Curr. Opin. Cardiol. 21 : 569-572, 2006. – reference: 12) Niwa, K., Siu, S.C., Webb, G.D. et al. : Progressive aortic root dilatation in adults late after repair of tetralogy of Fallot. Circulation 106 : 1374-1378, 2002. – reference: 17) Sakamoto, T., Matsumura, G., Kosaka, Y. et al. : Long-term results of Konno procedure for complex left ventricular outflow tract obstruction. Eur. J. Cardiothorac. Surg. 34 : 37-41, 2008. – reference: 13) Tan, J.L., Davlouros, P.A., McCarthy, K.P. et al. : Intrinsic histological abnormalities of aortic root and ascending aorta in tetralogy of Fallot : evidence of causative mechanism for aortic dilatation and aortopathy. Circulation 112 : 961-968, 2005. – reference: 6) Yuan, S.M., Shinfeld, A., Tager, S. et al. : Onset of neoaortic root dilation 18 years after an arterial switch operation. J. Cardiovasc. Med. (Hagerstown)9 : 298-300, 2008. – reference: 8) Schwartz, M.L., Gauvreau, K., del Nido, P. et al. : Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation. Circulation 110 : II128-132, 2004. – reference: 3) Niwa, K., Perloff, J.K., Bhuta, S.M. et al. : Structural abnormalities of great arterial walls in congenital heart disease : light and electron microscopic analyses. Circulation 103 : 393-400, 2001. |
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| Title | 成人先天性心疾患における大動脈基部拡大および上行弓部大動脈瘤の経験 |
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