重症連合弁膜症術後に施行した弓部大動脈瘤に対する血管内弓部再建術の1例

Branched Thoracic Endovascular Aortic Repair for Aortic Arch Aneurysm Following Severe Combined Valvular Disease：Report of a Case

はじめに　弓部大動脈瘤に対する通常の第一選択である人工血管置換術は，人工心肺使用，循環停止，低体温療法などの影響で侵襲が高く，ハイリスクな症例には開窓型ステントグラフトやデブランチ手技を併用した胸部ステントグラフト内挿術（TEVAR）が近年報告されている1，2）．われわれは，高齢でリスクの高い連合弁膜症に合併した弓部大動脈瘤に対して，弁膜症手術を先行し，二期的に自己開窓型Najuta（SBカワスミ社）を用いた枝付きTEVARを施行して良好な結果を得たので報告する．

A 79-years-old frail man with severe combined valvular disease was referred to our hospital. Furthermore, chest computed tomography （CT） showed a saccular aneurysm in the aortic arch. We chose two staged repairs for risk reduction. As a first stage double valve replacement and tricuspid annuloplasty were performed. Three months later, we performed successful branched thoracic endovascular aortic repair （TEVAR） used physician modified Najuta which had hydrogel-reinforced fenestrations to provide a more secure connection with the bridging graft than fenestrations alone. Staged surgery with branched TEVAR used physician modified Najuta is a useful strategy in patients who have complex cardiac disease combined with aortic arch aneurysm.