大動脈基部拡大と二尖弁を伴うStanford A型急性大動脈解離に対する自己弁温存基部再建術の1例

Valve-sparing Root Reimplantation for Stanford Type A Acute Aortic Dissection Combined with Aortic Root Dilation and Bicuspid Aortic Valve；Report of a Case

はじめに　自己弁温存大動脈基部再建術は，1990年代後半に報告されて以来，さまざまな施設で行われ，現在では確立された術式となっている．われわれは，大動脈基部拡大，先天性二尖弁を伴うStanford A型急性大動脈解離（AAD）に対して自己弁温存大動脈基部再建術（reimplantation法）を行った症例を経験し，良好な結果を得たので若干の文献的考察を含め報告する．

A 45-year-old male developed Stanford type A acute aortic dissection combined with aortic root dilation and congenital bicuspid aortic valve （BAV）. He had a Sieveres type 0 BAV, lateral subtype with right and left cusps. Valve-sparing root reimplantation was performed with decalcification of the cusps. Transthoracic echocardiography （TTE） at discharge revealed no aortic regurgitation, and peak velocity of BAV was 2.15 m/second, mean pressure gradient was 9.6 mmHg and aortic valve area was 2.15 cm2. TTE after 6 months revealed only slight elevation of the peak velocity to 2.78 m/second. To perform successful reimplantation in the case of BAV, anatomic orientation of the cusps should be approximately at 180° and the tissue of the cusps should either be normal or have only minor abnormalities. Valve-sparing root reimplantation for BAV needs a careful follow-up for progression of the aortic valve dysfunction.