右鎖骨下動脈起始異常を伴う弓部大動脈瘤に対する右半襟状切開手術

Total Arch Replacement via Right Hemicollar Incision and Mediansternotomy for an Arch Aneurysm with an Aberrant Right Subclavian Artery

右鎖骨下動脈起始異常（aberrant right subclavian artery：ARSA）は右鎖骨下動脈が大動脈弓の第4分枝として胸部下行大動脈より分岐する発生異常であり，その頻度は0.5～1.6％と報告され，大動脈弓部分枝の異常としてはもっとも多いとされている1，2）．われわれは右半襟状切開を行い良好な結果を得たので，文献的考察を加え報告する．

The patient was 72-year-old-woman. Computed tomography （CT） revealed an arch aneurysm with an aberrant right subclavian artery （ARSA）. We performed total arch replacement via right hemicollar incision and median sternotomy. Arch replacement and right subclavian artery reconstruction were performed under hypothermic circulatory arrest with selective cerebral perfusion. This approach allowed selective perfusion and reconstruction of the ARSA in the same field of view as total arch replacement. Because the right side was non-recurrent laryngeal nerve, we were able to perform the surgery without concern for bilateral recurrent nerve palsy. The patient had no cerebral complication and her postoperative course was uneventful.