左鎖骨下動脈-下行大動脈バイパス術を施行した成人大動脈縮窄症の1例

Subclavian-aortic Bypass for Management of Aortic Coarctation in Adults：Report of a Case

はじめに　大動脈縮窄症は欧米では先天性心疾患の5〜8％，日本では2.8％に認められ，多くは成人期前に治療されるが，単純型で縮窄の程度が軽いと成人まで診断されず，高血圧，心不全，下肢虚血症状などから診断されることが多い1）．治療としては解剖学的血行再建，非解剖学的バイパス，血管内治療がある．われわれは，左鎖骨下動脈-下行大動脈バイパス術を選択した症例を報告する．

A 57-year-old man presented to the hospital with dyspnea. A diagnosis of hypertensive heart failure was made, and treatment was initiated. However, his ankle-brachial index had decreased to 0.61 on the right and 0.56 on the left side, and he had intermittent claudication with decreased renal function （serum creatinine, 1.73 mg/dl）. Thoracoabdominal contrast-enhanced computed tomography showed severe stenosis with a diameter of 2.2 mm in the distal arch and marked development of collateral vessels, and a diagnosis of aortic stenosis was made. Vascular catheterization revealed a pressure gradient of 60 mmHg between the upper and lower extremities. We performed a left-sided open thoracotomy and left subclavian-descending aortic bypass （16 mm J Graft, Shield）. The patient recovered without postoperative complications, and the pressure gradient between the upper and lower extremities eventually decreased to 6 mmHg.