上行大動脈瘤破裂を手術により救命した1例

Ruptured Ascending Aortic Aneurysm：Report of a Case

はじめに　上行大動脈瘤は高齢者では主にアテローム性動脈硬化によって引き起こされ，若年者でのもっとも一般的な原因はMarfan症候群である1）．上行大動脈瘤が心囊内で開放破裂すれば，瞬時に重度の心タンポナーデとなり死亡にいたることは自明であるので，上行大動脈瘤破裂の報告は少なく，救命例となるとまれである．上行大動脈瘤が開放破裂したものの，破裂孔がごく小さいうえに右房と接していたため一時的に止血され，手術により救命しえた症例を経験したので報告する．

A 62-year-old man was transferred to our hospital for consciousness loss, and contrast-enhanced computed tomography （CT） scans showed a 50-mm ascending thoracic aortic aneurysm （ATAA） with a little pericardial effusion. The patient became stable and was admitted for observation without any invasive treatments in the department of cardiology. On the 5th hospital day, however, repeated CT scans revealed increased pericardial effusion. Bloody fluid was drained in pericardiocentesis, and the patient was referred to our department. Ruptured ATAA was diagnosed, and emergency surgery was conducted. Although there was no bleeding after removing intrapericardial hematoma, bleeding from a pinhole of the aortic right side adjacent to the right atrium was recognized when the dilated proximal ascending aorta was raised to the left. Aortic root and ascending aortic replacement were performed because the aneurysm reached the ostium of the right coronary artery. Postoperative course was uneventful, and the patient was discharged on postoperative day 29.