大動脈弁置換術後遠隔期に上行大動脈切開縫合部の瘤化をきたした2例

Para-anastomotic Aneurysm in the Ascending Aorta Late After Aortic Valve Replacement：Report of Two Cases

はじめに　本稿では，大動脈弁閉鎖不全に対する大動脈弁置換術後の遠隔期に，大動脈切開縫合線のフェルトストリップを中心とした大動脈瘤が生じ再手術を要した2例を経験したので報告する．

Case 1 was a 59-year-old man who underwent aortic valve replacement （AVR） at the age of 38, for aortic regurgitation. Case 2 was a 51-year-old man who underwent AVR at the age of 34, for aortic regurgitation. Both cases required surgery for ascending aortic aneurysms. These patients showed aneurysm at the site of the prior aortotomy. In both of the patients used felt-strip was used for closing aortotomy. Intraoperative findings showed enlargement of the aorta around the felt-strip, which was a finding of true aneurysm. Both cases underwent ascending aortic replacement. The mechanism of aortic aneurysm development was thought to include persistent mechanical stimulation by the felt-strip and ischemia of the vasa-vasorum due to compression of the felt-strip. The use of felt-strips for the aortotomy suture should be avoided, especially in young patients.