大動脈肺動脈瘻を呈した弓部大動脈瘤破裂の1例

Aortopulmonary Fistula Caused by Rupture of an Aortic Arch Aneurysm Successfully Treated by Surgery；Report of a Case

はじめに　弓部大動脈瘤破裂に伴う大動脈肺動脈瘻はまれな病態である1）．シャント血流による急性心不全で発症することが多く，救命のためには外科的治療が必要になることが多い．大動脈瘤の位置や瘻孔の形成部位によってさまざまな術式や治療戦略が報告されているが，確立されたものはなく，いまだに手術を行っても救命できない例もある．われわれは，弓部大動脈瘤破裂に伴う大動脈肺動脈瘻に対して，手術により良好な経過を得た1例を経験したので報告する．

An 81-year-old woman who presented with chest and back pain was diagnosed as aortopulmonary fistula caused by rupture of an aortic arch aneurysm and was transferred to our hospital for surgical treatment. Additionally, she was diagnosed with aortic dissection （Stanford type B）. Total arch replacement with open stent-grafting and direct closure of aortopulmonary fistula were performed because of her exacerbation of congestive heart failure. Manual compression of fistula during cardiopulmonary bypass was effective to control massive shunt. The patient recovered uneventfully and was transferred to other hospital for rehabilitation on postoperative day 24.