高度石灰化上行大動脈に対する遮断方法の工夫

Surgical Management of a Severely Calcified Ascending Aorta Using Intra-Aortic Balloon Occlusion

高齢化や生活習慣病による動脈硬化性大動脈弁狭窄症（AS）が増加している．手術に際し，高度に石灰化した上行大動脈に対する鉗子遮断は脳合併症の原因となる．これを回避するため大動脈遮断方法を工夫し，安全に大動脈弁置換術（AVR）を施行したので報告する．

A severely calcified ascending aorta increases the risk of perioperative cerebral damage in cardiac surgery. Conventional aortic valve replacement using an external aortic cross clamp may be dangerous in patients with this morbidity. We used an intra-aortic balloon occlusion catheter（IABOC）to minimize risks of aortic valve replacement（AVR） in an 81-year-old man with severe aortic stenosis combined with a severely calcified aorta. IABOC was introduced to the ascending aorta via the right femoral artery by esophageal echocardiography. The precise site of the inflated balloon was confirmed by the pressure of the right radial artery and was secured by 2 tourniquets around the ascending aorta. The postoperative course was uneventful. Our technique can contribute to prevention of embolic complications in some patients with a severely calcified ascending aorta.