多発外傷を伴った上行大動脈・大動脈基部損傷の1例

Traumatic Disruption of the Aortic Root and the Ascending Aorta with Multisystem Trauma；Report of a Case

はじめに　外傷による鈍的大動脈損傷の中でも大動脈基部損傷はまれであり，発症すれば致死的である．われわれは，開心術の既往のある患者に発症した多発外傷を伴う上行大動脈・基部損傷に対し，受傷後2日目に手術を行い，救命しえたので報告する．

We report a case of traumatic disruption of the aortic root with multisystem trauma. A 45-year-old male was suffered from multiple injuries including subarachnoid hemorrhage, lung contusion, retroperitoneal hematoma and femoral bone fracture caused by a traffic accident. He had a history of 3 cardiac surgeries including repair of atrioventricular septal defect and mitral valve replacement using a mechanical valve. Contrast-enhanced computed tomography （CT） revealed leakage of the contrast medium from the aortic root and a filling defect on the right coronary artery. Because of hemorrhagic complications, emergency operation was avoided. He was operated 2 days after the trauma. Laceration of the left-coronary sinus and the non-coronary sinus was observed. Bentall operation was performed and the right coronary artery （RCA） was bypassed with a saphenous vein graft. He was treated with open fixation of the right femur 14 days after the operation and was discharged 58 days after the 1st operation.