経カテーテル的大動脈弁置換術中に発症したStanford B型急性大動脈解離の1例

Stanford Type B Acute Aortic Dissection Associated with Transcatheter Aortic Valve Implantation：Report of a Case

はじめに　経カテーテル的大動脈弁置換術（transcatheter aortic valve implantation：TAVI）の合併症として，Stanford B型急性大動脈解離はきわめてまれである．われわれは，大腿動脈アプローチによるTAVIの手術中にStanford B型急性大動脈解離の発症を経験したので，文献的考察とともに報告する．

Transcatheter aortic valve implantation （TAVI）-related Stanford type B aortic dissection is an extremely rare but potentially fatal complication. Here, we present a case of 82-year-old man who developed acute type B aortic dissection during transfemoral TAVI. During successful TAVI procedure, dissection in the descending aorta was demonstrated by transesophageal echocardiography. Computed tomography （CT） clearly showed Stanford type B aortic dissection and an intimal tear in severely tortuous part of the descending aorta. Cause of aortic dissection was supposed to be related to the guidewire or the device that passed across affected position. The patient showed no complication associated with aortic dissection, such as rupture or malperfusion. Therefore, he was treated conservatively, and follow-up CT confirmed progressive clotting of the false lumen. Although the indication for TAVI has got broaden recently, physicians should be always aware of possible aortic dissection.