虚血性僧帽弁閉鎖不全症を合併した広範囲胸部大動脈瘤に対し二期的ハイブリッド手術を施行した1例

Two-stage Hybrid Repair for Extensive Thoracic Aortic Aneurysm with Ischemic Mitral Regurgitation：Report of a Case

はじめに　弓部大動脈瘤に対する治療法は全弓部置換術（TAR）が第一選択である1）が，近年さまざまな術式が選択可能となった2）．われわれは低心機能，虚血性僧帽弁閉鎖不全症（IMR）を合併した広範囲胸部大動脈瘤（TAA）に対しtotal debranching，僧帽弁輪形成術（MAP）後に二期的胸部ステントグラフト（SG）内挿術（TEVAR）を施行したので報告する．

The patient was a 71-year-old man with a history of hypertension and myocardial infarction. Transthoracic echocardiography revealed a left ventricular ejection fraction of 26％ and moderate mitral regurgitation. Computed tomography （CT） showed a wide-ranging aneurysm from the aortic arch to the abdomen. Maximum short diameter of the thoracic aortic aneurysm （TAA） was 54 mm. We planned a two-stage hybrid surgery to avoid a long aortic clamp time. During the first surgery, we performed mitral annuloplasty （MAP） and a total debranching procedure using a three-branch graft from the ascending aorta to the brachiocephalic artery, left common carotid artery, and left axillary artery under cardiopulmonary arrest. Thoracic endovascular aortic repair （TEVAR） was performed 20 days after the first surgery. No complications were encountered and the patient was discharged 31 days after the initial surgery. Hybrid surgery involving MAP and second-stage TEVAR after branch reconstruction was effective in this case of extensive TAA with low cardiac function.