右側大動脈弓に合併した左鎖骨下動脈起始異常を伴うKommerell憩室に対する二期的手術の1例

Two-stage Repair of Kommerell Diverticulum with Right Aortic Arch and Aberrant Left Subclavian Artery：Report of a Case

はじめに　Kommerell憩室は大動脈弓部の発生異常で，鎖骨下動脈起始異常を伴うものが多い．破裂や大動脈解離，食道気管圧迫の危険性があり手術治療を要する．われわれは右側大動脈弓に合併した左鎖骨下動脈起始異常を伴うKommerell憩室に二期的手術を行い，良好な結果を得たため報告する．

A 52-year-old woman was referred to our hospital with a chief complaint of difficulty in swallowing and coughing while eating. Enhanced computed tomography （CT） revealed a Kommerell diverticulum with right aortic arch and abberant left subclavian artery. The diverticulum compressed the esophagus and trachea. We avoided total aortic arch replacement because there were risks of circulatory arrest, selective cerebral perfusion and neurological complication including injury to recurrent laryngeal nerve. Therefore, we scheduled two-stage repair of the diverticulum. First, we performed axillo-axillary artery bypass and left subcalvian artery coil embolization. After 7 days, descending aorta replacement including a diverticulum with right anterior lateral 3rd intercostal thoracotomy and lower body partial extracorporeal circulation was performed. The postoperative course was uneventful and she was discharged 20 days after the initial surgery.