異所性右鎖骨下動脈を伴った亜急性大動脈解離に対する弓部置換術の1例

Anatomical Repair of Total Arch Replacement for Stanford Type B Subacute Aortic Dissection with Aberrant Right Subclavian Artery：Report of a Case

はじめに　異所性右鎖骨下動脈（ARSA）は先天性の弓部分枝異常であり，右鎖骨下動脈が大動脈弓の第4分枝として左鎖骨下動脈より遠位から分岐する．その起始部には瘤形成を伴うKommerell憩室を認め大動脈解離や瘤破裂を合併することがあるが，その手術介入の時期や定型的な術式は確立しておらず，標準化されたものはない．

A 45-year-old man complaining of chest and back pain due to acute aortic dissection was referred to our department. A contrast enhanced computed tomography （CT） scan showed Stanford type B aortic dissection with Kommerell diverticulum and aberrant right subclavian artery. The patient underwent antihypertensive treatment for one month. Despite the successful treatment, CT scan revealed a 5 mm false lumen dilatation in this period. We decided to close the primary entry. The operation was performed through median sternotomy；after establishing cardio-pulmonary bypass, the ostium of the aberrant right subclavian artery （ARSA） was sutured closed and anastomosed the ARSA and right common carotid artery. Total arch replacement was performed using frozen elephant trunk technique. His postoperative course was uneventful.