右室梗塞を合併したStanford A型急性大動脈解離に対し経皮的冠状動脈形成術後に全弓部置換術を行った1例

Acute Stanford Type A Aortic Dissection with Right Ventricular Infarction Treated with Total Arch Replacement After Percutaneous Coronary Intervention：Report of a Case

はじめに　Stanford A型急性大動脈解離（ATAAD）の手術成績は向上しているが，冠状動脈灌流障害を伴う症例は予後不良といわれている．われわれは，右冠状動脈の米国心臓協会（AHA）分類segment3までの長区間へ解離が進展し，右室梗塞を伴っていたATAADに対して経皮的冠状動脈形成術（PCI）を先行した後，全弓部置換術およびオープンステント（OS）内挿術を施行し救命した症例を経験したので報告する．

A 60-year-old man was admitted to our hospital with chest and back pain. Electrocardiogram, echocardiography, and contrast-enhanced computed tomography （CT） confirmed a Stanford type A acute aortic dissection with right ventriclar infarction and left ventricular inferior wall asynergy due to right coronary artery malperfusion. The patient presented with shock vital signs. So, immediately percutaneous coronary intervention （PCI） was performed to obtain the right coronary revascularization, after which total arch replacement and frozen elefant trunk was performed. Postoperatively, the patient remained stable without right heart failure. In patients with right ventricular infarction, preoperative PCI prior to surgery may be a useful option.