Valsalva洞・右房交通を合併した大動脈解離の1例

Aortic Dissection with Fistula between the Sinus of Valsalva and the Right Atrium：Report of a Case

はじめに　大動脈・心内腔シャントは急性大動脈解離のまれな合併症である1）．われわれは，冠状動脈バイパス術（CABG）施行6年後にValsalva洞・右房交通を合併する大動脈解離を発症した症例に対して人工血管置換術を施行し，良好な結果を得たので報告する．

We report a case of a 72-year-old male with Stanford type A aortic dissection with a fistula between the sinus of Valsalva and the right atrium. Six years before, the patient had undergone coronary artery bypass grafting （CABG） using the left internal thoracic artery and two saphenous vein grafts. This time he was admitted to our hospital due to dyspnea. Computed tomography revealed Stanford type A aortic dissection. Conservative treatment was first adopted, because severe adhesion was expected after CABG and the false lumen of the aorta was partially thrombosed. However, heart failure could not be managed. Repeated transthoracic echocardiography revealed aorto-right atrial shunt. Retrospective reexamination of the echocardiography, the shunt had existed since admission. We performed replacement of the ascending aorta and reimplantation of the saphenous vein grafts. The patient recovered uneventfully.