大動脈縮窄症術後再狭窄に対する正中切開によるsubclavian flap法と鎖骨下動脈再建術

Subclavian Flap Angioplasty and the Reconstruction of the Distal Subclavian Artery for Recurrent Coarctation of the Thoracic Aorta through the Median Sternotomy

大動脈縮窄症において，大動脈弓再建術後再狭窄に対する外科治療は，大動脈形態や手術時年齢によってさまざまな術式が報告されている1，2）．われわれは直接吻合法による大動脈弓再建術後の再狭窄に対し，正中切開アプローチにより鎖骨下動脈フラップ法（SCF）と鎖骨下動脈再建を同時に行い，良好な経過を認めた2例を経験したので報告する．

The Procedure of the subclavian flap angioplasty and reimplantation of the distal subclavian artery into the left carotid artery was used in 2 infants （4-month-old and 5-month-old） with recurrent coarctation of the thoracic aorta through the median sternotomy. After median sternotomy, the aortic arch and its branches were extensively dissected. The descending aorta was minimally dissected. An arterial cannula was inserted into the brachiocephalic artery and the cardiopulmonary bypass was started by bicaval cannulation. The aortic root cannula was inserted into the aortic root and T-connected with the side hole of the brachiocephalic arterial cannula. The 2 cases underwent surgery with selective cerebral and myocardial perfusion. The left subclavian artery was transected and the subclavian flap technique was used to enlarge the recoarctation of the thoracic aorta. Then, the distal end of the transected left subclavian artery was reconstructed by performing an end to side anastomosis to the left carotid artery. This procedure has several advantages；①minimal dissection of the descending aorta is required, ②the use of prosthetic material is avoided, ③it prevents ischemic arm complication, ④additional skin incision is avoided.