完全内臓逆位症に併発した三尖弁閉鎖不全症を伴うStanford A型大動脈解離

Stanford Type A Aortic Dissection with Tricuspid Regurgitation in a Patient with Situs Inversus Totalis

急性Stanford A型大動脈解離は致命的な疾患であり，手術死亡率は8～26％といわれている1～5）．また，完全内臓逆位は正常な内臓の鏡像転位を特徴とする先天性疾患であり，時に手術を正確に行うことを困難にさせうる．われわれは，完全内臓逆位を伴ったStanford A型大動脈解離と三尖弁閉鎖不全症に対して手術加療を行った症例を経験したため報告する．

Situs inversus totalis is a congenital anomaly characterized by a mirror image transposition of the normal visceral organs, which makes it difficult to perform aortic surgery accurately. Stanford type A aortic dissection in patients with this condition is very rare and difficult to assess and manage. We report a case of Stanford type A aortic dissection with situs inversus totalis. The patient presented with severe tricuspid regurgitation with annulus enlargement due to chronic atrial fibrillation, requiring ascending aortic replacement and tricuspid annuloplasty. These procedures were performed after the operator swapped the left and right positions during the operation. Postoperative course was uneventful. By carefully checking the preoperative computed tomography images and changing the operator’s position during the operation, it is possible to safely perform Stanford type A aortic dissection surgery in patients with situs inversus totalis.