広範囲大動脈置換術を施行した右側大動脈弓合併non-A non-B型大動脈解離

Non-A Non-B Aortic Dissection Complicated with Right Aortic Arch Treated by Extended Thoracic Aortic Repair

右側大動脈弓（RAA）に合併する広範囲大動脈瘤はまれで，手術術式に関するコンセンサスは得られていない．われわれはRAAに合併したnon-A non-B型大動脈解離に対し上行-弓部-下行大動脈置換術を施行したので報告する．

A 44-year old man with a history of Stanford type B acute aortic dissection was admitted for the treatment of acute aortic dissection. Computed tomography （CT） scan showed a descending entry-type non-A non-B aortic dissection with a maximum diameter of 65 mm occurring in a patient with Edwards typeⅢ right aortic arch whose left subclavian artery was obliterated. The patient was initially treated conservatively and underwent one-stage extended aortic repair from the ascending aorta to the descending thoracic aorta via median sternotomy 22 days after the symptom onset. Although the patient suffered from right empyema postoperatively, he was discharged from the hospital on postoperative day 64 after 4 weeks antibiotics therapy. The patient was also complicated by right recurrent nerve palsy, hoarseness improved over the 8 months after surgery.