心原性ショックを呈した重症大動脈弁狭窄症症例に対しapicoaortic conduit手術を施行した1例

Apicoaortic Conduit in a Patient with Cadiogenic Shock Secondary to Critical Aortic Valve Stenosis

要旨　症例は83歳の女性．高度の左室機能障害を認める重症大動脈弁狭窄症の診断で他院より手術目的にて当院転院となった．上行大動脈に高度の石灰化を認め，さらに高度の左室収縮障害を認めたためapicoaortic conduitの適応と判断したが，手術待機入院中に心原性ショックを生じた．幸い，強心薬の投与などにより循環は安定したため，翌日，準緊急的に手術を施行した．術中，術後合併症は生じず，術後速やかに心不全症状は消失した．

　An 83-year-old woman presented with severe aortic stenosis, severe calcification of the ascending aorta, and severe left ventricular dysfunction. Echocardiography revealed mean and peak gradients of 71 mmHg and 98 mmHg, respectively. Left ventricular ejection fraction was 23%. She was admitted to our institution for elective surgery and fell into cardiogenic shock during hospitalization;aortic valve bypass was conducted the next day. A left ventricular to descending thoracic aortic bypass conduit containing a 19-mm freestyle stentless bioprosthesis was inserted through left thoracotomy using cardiopulmonary bypass and ventricular fibrillation. The patient was extubated the day after surgery and was neurologically stable. She remained in the ICU for two days, but required postoperative rehabilitation due to the long period of being bedridden before surgery. She was discharged in good condition on postoperative day 27, and is currently alive and well 1.5 years postoperatively. Apicoaortic conduit is potentially superior to conventional AVR in myocardial protection.