腕頭動脈による気管圧排に対して全弓部大動脈置換術を施行したbovine aortic archの1例

Total Arch Replacement due to Tracheal Compression by Brachiocephalic Artery with Bovine Aortic Arch：Report of a Case

はじめに　腕頭動脈と左総頸動脈が共通幹から分岐，もしくは左総頸動脈が腕頭動脈から分岐している形態は一般的にbovine aortic arch（BAA）と呼ばれ，胸部大動脈疾患と関連があると報告されている1）．われわれは，BAAを伴う腕頭動脈による気管圧排の症例に対して全弓部大動脈置換術を施行し，良好な結果を得たので報告する．

A 78-year-old female presented to our institution with a dry cough and dyspnea. Chest computed tomography （CT） revealed tracheal stenosis caused by compression from a brachiocephalic artery with a bovine aortic arch. Subsequently, surgery was performed in which the brachiocephalic artery was resected, and a total arch replacement using a four-branched graft was completed. We paid particular attention to the graft branches, making sure to avoid contact with the trachea. Both the patient’s cough and dyspnea dissipated after the surgery, and a CT revealed the tracheal stenosis had been completely relieved. The patient has remained in good condition for the past three years since the surgery showing no respiratory symptoms or thoracic aortic disease. Because the bovine aortic arch is a known risk factor for thoracic aortic disease, rather than simply reconstructing the brachiocephalic artery, we chose a more aggressive surgical treatment to prevent any possible future thoracic aortic disease.