急性A型大動脈解離に対する上行大動脈置換術後のBentall手術とオープンステントグラフトを用いた弓部大動脈置換術

Bentall Procedure and Total Arch Replacement with an Open Stentgraft after Ascending Aortic Replacement for Acute Type A Aortic Dissection

急性A型大動脈解離に対する上行大動脈置換術後遠隔期に，再手術が必要となる場合がある．近位側再手術としてBentall手術および遠位側再手術としてオープンステントグラフト（OSG）1）を用いた弓部大動脈置換術を同時に行った症例を経験したので，報告する．

A 40-year-old man underwent ascending aortic replacement for acute type A aortic dissection. Eight years later, Bentall procedure and total arch replacement with an open stentgraft （OSG） were performed due to enlargement of the aortic root and distal arch dissection as well as exacerbation of aortic valve incompetence. The computed tomography （CT） taken at 22 months postoperatively showed better stentgraft expansion than that immediately after the operation, reduction in the diameter of the distal aortic arch, and thrombosis of the false lumen from the aortic arch to the entire descending aorta. However, the CT taken at 33 months postoperatively revealed a new entry to the distal end of the stentgraft and blood flow in the false lumen. Although OSG is useful for extensive aortic aneurysm, strict follow-up is necessary in OSG for aortic dissection.