高安血管炎による大動脈弁輪拡張症の1例

Annuloaortic Ectasia Induced by Takayasu’s Arteritis：Report of a Case

はじめに　高安血管炎（Takayasu’s arteritis）は外膜より始まり血管全層に及んだ血管炎症による動脈狭窄あるいは動脈瘤を引き起こす病態であり，基本的には炎症の慢性安定期での手術介入が推奨されている．われわれは未診断の高安血管炎による大動脈弁輪拡張症および上行大動脈瘤に対して手術治療を経験したため，報告する．

A 50-year-old male was diagnosed with aortic annulus ectasia （AAE） and aortic valve regurgitation （AR）, and was thus referred to our department for surgery. Computed tomography （CT） revealed a Valsalva aneurysm with a maximal diameter of 52 mm. Echocardiography revealed severe AR with left ventricular enlargement ［left ventricular internal dimension in diastole （LVDd） 85 mm］. The creatinine （CRE） level was 0.97 mg/dl, and the C-reactive protein （CRP） level was 1.92 mg/dl. David’s procedure was initiated as a therapeutic intervention；However, severe adhesion and enlargement of the ascending aorta were observed after it was exposed during cardiopulmonary bypass （CPB）. Based on this finding, the patient was suspected of having Takayasu’s arteritis, and thus a Bentall procedure, with ascending aorta replacement by selective cerebral perfusion （SCP） and systemic cooling, was performed. Pathological examination revealed an inflammatory reaction from the adventitia to the intima with mononuclear cell infiltration, leading to a histological diagnosis of Takayasu’s arteritis. The postoperative course was uneventful, and the patient was discharged on postoperative day 21. Steroids were used to treat Takayasu’s arteritis and to prevent its recurrence after discharge.