高度の胸郭変形を伴う囊状遠位弓部大動脈瘤に対する前側方開胸下部胸骨部分切開アプローチによるパッチ形成術の1例

Patch Repair by Anterolateral Thoracotomy with Partial Sternotomy for Saccular Aortic Arch Aneurysm with Severe Thoracic Deformity：Report of a Case

はじめに　囊状弓部大動脈瘤に対するパッチ形成術に関しては，術後遠隔期に瘤が再発しやすいことが知られており，標準的な術式は弓部大動脈置換術（以下，弓部置換術）となる．しかし，動脈瘤の状態によっては弓部置換術が施行困難な症例も存在する．われわれは，術中所見により弓部置換術が困難と判断し，パッチ形成術を実施した1例を報告する．

An 87-year-old male was referred to our hospital for surgery of saccular aortic arch aneurysm. As he had a history of thoracoplasty on his left side due to pulmonary tuberculosis, his aortic arch adhered to the apex of the left thorax. Total arch replacement （TAR） via median sternotomy was considered difficult, and anterolateral thoracotomy with partial sternotomy （ALPS） was performed. During surgery, we considered TAR difficult even with ALPS approach. Taking account of his age, aneurysmectomy and patch repair were chosen instead of TAR to shorten operation time. Although he suffered from diffuse cerebral infarction, he was discharged without neurological deficit at 39 days after operation.