胸骨裏面に接する巨大な大動脈瘤の2例

Retrosternal Giant Aortic Aneurysm；Report of Two Cases

はじめに　胸骨裏面に接する巨大大動脈病変に対し，われわれは手術の工夫（inferior T-shaped ministernotomy）を報告してきたが1），大動脈病変の部位や拡大範囲，病態によっては，その方法では対応不可能な複雑大動脈病変に遭遇し，さまざまな工夫が必要となる1～5）．われわれは，胸骨裏面に接する大動脈病変の2例に，胸骨切開前の低体温と左室ベント挿入を基本戦略として手術を施行し，治験を得たので報告する．

This is a 2-case report of successful aortic repair surgery for the retrosternal giant aortic aneurysm. Our surgical strategy is “deep hypothermia and left ventricular （LV） unloading under cardiopulmonary bypass before approaching to the aortic aneurysm” in case of possible catastrophic bleeding. Case 1, a 64-year-old woman, had a retrosternal pseudoaneurysm （80 mm） at the distal anastomosis of a Dacron graft used to replace the ascending aorta 7 years before. An LV vent tube was cannulated via the right upper pulmonary vein through an inferior T-shaped ministernotomy. Case 2, an 86-year-old woman, had a retrosternal chronic aortic dissecting aneurysm （66 mm）. An LV vent cannula was inserted via the LV apex through a left minithoracotomy. Arch replacement and ascending aorta replacement were performed in Case 1 and 2, respectively, without cardiac, neurological, or any other complications. This strategy is safe and useful in a case with complex aortic disease.