大動脈弁再置換術後に急性大動脈解離を発症し早期診断により救命しえた1例

Acute Aortic Dissection after Reoperative Aortic Valve Replacement with Early Diagnosis：Report of a Case

はじめに　周術期の合併症として急性大動脈解離は非常にまれであり，Ruchatらの報告では開心術における周術期の急性大動脈解離の発生率は0.12％とされている1）．術中発症においては経食道心エコーや肉眼的所見で診断されることが多いとされている2）．われわれは，大動脈弁再置換術後に発症した急性大動脈解離の手術例を経験したので，若干の文献的考察を加味して報告する．

Acute aortic dissection is a rare and potentially catastrophic perioperative complication of cardiac surgery. A 72-year-old woman underwent aortic valve replacement with a bioprosthetic valve for aortic regurgitation seven years earlier. She experienced respiratory distress on exertion and was diagnosed with prosthetic valve dysfunction. Reoperative aortic valve replacement with a bioprosthetic valve was performed. On postoperative day eight, contrast-enhanced computed tomography, which was performed to evaluate persistent high levels of inflammatory response, revealed acute DeBakey typeⅠaortic dissection. Emergency ascending aortic replacement was successfully performed. The patient was discharged on postoperative day 19 without any complications. Acute aortic dissection after cardiac surgery is rare；however, physicians should be aware of this possible complication.