左鎖骨下動脈-下行大動脈バイパス術を施行した成人大動脈縮窄症の1例

Subclavian-aortic Bypass Grafting for Aortic Coarctation in Adults：Report of a Case

はじめに　大動脈縮窄症は欧米では先天性心疾患の5～8％，日本では2.8％に認められ，多くは幼少期に治療されるが，縮窄の程度が軽いと成人まで診断されないこともある1）．治療法としては降圧薬内服による血圧管理，解剖学的血行再建，非解剖学的バイパス，血管内治療が選択される．われわれは左鎖骨下動脈-下行大動脈バイパス術を選択した症例を経験したので報告する．

A 56-year-old woman with a congenital bicuspid aortic valve presented with a cough. She was diagnosed with adult congenital coarctation of the aorta on computed tomography （CT） and referred to our institution. The blood pressure gradient between the upper and lower extremities was approximately 70 mmHg. She also had mild renal impairment. She underwent left subclavian artery to descending aorta bypass through a 5th left thoracotomy with partial extracorporeal circulation. The operation was successful and the postoperative course was uneventful. The pressure gradient between the upper and lower extremities eventually decreased to 5 mmHg. The left subclavian artery to descending aorta bypass is an effective operation for this disease.