大動脈縮窄/離断症に対する自己心膜補塡による大動脈弓再建術

Reconstruction of the Aortic Arch with an Autologous Pericardial Patch in Aortic Coarctation and Interruption

大動脈縮窄症（CoA）/離断症（IAA）に対する大動脈弓再建では直接吻合法が選択される場合が多く，新生児，乳児期に対する早期・中期成績は良好である1）．しかし，直接吻合法は術後気管支狭窄や吻合部への過度の緊張による再狭窄2）などの合併症が報告されている．われわれもCoA/IAAに対する大動脈弓再建は直接吻合法を第一選択としているが，2013年以降は術後合併症が懸念される症例に対して大動脈弓小彎側に自己心膜を補塡する再建法を行っている．自己心膜補塡による大動脈弓再建時に二心室修復（BVR）を行った症例について，経過を検討し報告する．

Backgrounds：Direct anastomosis such as end-to-end anastomosis or extended aortic arch anastomosis are the most commonly used technique to repair aortic coarctation or interrupted aortic arch. Direct anastomosis of the aorta sometimes results in restenosis and/or bronchial compression. To avoid these complications, we have used the technique of the aortic reconstruction using an 0.6％ glutaraldehyde-fixed autologous pericardium.

Patients and Methods：The procedure was performed in 6 patients；4 with aortic coarctation and 2 with aortic interruption. Prognosis, aortic diameter, and the aortic shape measurement on 3-dimensional computed tomography （3D-CT） were examined postoperatively.

Results：There were no early or late deaths. There was no case of recurrent aortic arch obstruction and/or bronchial compression, The postoperative A/T ratio was 0.48±0.04 on 3D-CT.

Conclusions：Reconstruction of the aortic arch with a 0.6％ glutaraldehyde-fixed autologous pericardium in an aortic coarctation and interruption showed excellent early and midterm outcomes. There were no complications such as bronchial compression or recoarctation. We believe that this technique leads to a higher success for reconstructing the arch to a near to normal morphology and avoiding the so-called Gothic arch, which has been reported to be associated with late complications of hypertension.