CarrelパッチによるBentall変法術後に右冠状動脈入口部瘤を合併したMarfan症候群の1例

Right Coronary Ostial Aneurysm after Modified Bentall Procedure with Carrel Patch Technique in a Patient with Marfan Syndrome：Report of a Case

はじめに　近年，大動脈基部置換術においてBentall変法が標準術式となり，吻合部仮性動脈瘤は減少傾向になった1，2）．しかしMarfan症候群において，冠状動脈瘤は増加傾向であり，多くは冠状動脈ボタンの吻合部分に残存する大動脈壁の拡大である1，3，4）．われわれはBentall変法術後17年目に，Carrelパッチ法（CP法）で再建した右冠状動脈自体の入口部に瘤形成を認めた症例を経験したので，若干の文献的考察を含めて報告する．

A 58-year-old man with Marfan syndrome visited our clinic for a routine examination. He had undergone a modified Bentall procedure with Carrel patch technique for annuloaortic ectasia 15 years previously. Computed tomography revealed an aneurysm of 43×57 mm in diameter at the right coronary ostium. He underwent resection of the aneurysm and coronary reconstruction using Piehler technique. He was discharged on the 37th postoperative day when his renal function recovered. Although the modified Bentall procedure may improve the surgical outcome, long-term follow-up is important because of various postoperative anastomotic complications in patients with Marfan syndrome.