急性大動脈解離術後に吻合部内フェルト反転により生じた溶血性貧血

Hemolytic Anemia due to an Inverted Felt Strip on Anastomosis in the Ascending Aorta for Acute Aortic Dissection

Stanford A型急性大動脈解離には救命のために緊急手術が必須であるが，その大動脈断端形成時には血管壁が脆弱で易出血性であり，さまざまな補強方法が選択されている1〜3）．われわれは2003年より大動脈壁の内外にフェルトを当てて補強し，断端形成を行っているが，内フェルトの内反により溶血性貧血を発症し修復術を行った2例を経験した．その経験をふまえて断端形成のフェルト内の縫合線の位置に注意した結果，以降同様の合併症は起こっていない．われわれの経験を報告する．

During surgery for acute aortic dissection, reinforcing anastomoses in the aorta with felt strips is helpful for hemostasis. We had two cases of hemolytic anemia that developed due to inversion of an inner felt strip that was applied at the proximal anastomosis in the ascending aorta. A 78-year-old woman underwent ascending aorta replacement for type A aortic dissection, and over the next 2.5 years, she gradually developed hemolytic anemia and underwent reoperation. A 47-year-old woman also had to undergo reoperation due to hemolytic anemia 17 days after ascending aorta replacement for type A aortic dissection. Based on these experiences, we make suture line in the felt much more proximal, and no further cases of hemolytic anemia have occurred since then.