食道癌術後の胸骨後胃管再建患者に対する開心術の1例

Cardiac Surgery in a Patient with a Retrosternal Gastric Tube Reconstruction After Esophagectomy：Report of a Case

はじめに　胸骨後胃管再建術後症例に対する心臓手術はまれであり，心臓への到達法の選択や再建胃管・右胃大網動脈の温存に配慮が必要である．われわれは胸骨後胃管再建後の連合弁膜症に対し胸骨正中切開で開心術を行い，良好な経過を得たため報告する．

Cardiac surgery after retrosternal gastric tube reconstruction presents significant technical challenges because of interference with the median sternotomy approach. We report a 67-year-old man who successfully underwent aortic valve replacement and mitral valve repair a year after subtotal esophagectomy with retrosternal gastric tube reconstruction for esophageal cancer. The gastric tube was carefully mobilized using a combined laparoscopic and cervical approach, allowing safe median sternotomy without injury to the right gastroepiploic artery. Both valve procedures were completed successfully under cardiopulmonary bypass. The patient resumed oral intake on postoperative day 4 and was transferred for rehabilitation on day 15. This case illustrates that with elaborate preoperative planning and careful intraoperative management, complex cardiac surgery can be performed safely even after retrosternal gastric tube reconstruction.