超重症大動脈弁狭窄症と冠動脈狭窄を合併した高齢者の大腿骨転子部骨折の麻酔経験

The Anesthetic Management for an Intertrochanteric Fracture in an Elderly Patient with Very Severe Aortic Valve Stenosis and Coronary Artery Stenosis

要旨

　88歳，女性。右大腿骨転子部骨折に対し骨接合術が予定された。術前評価で手術適用の無症候性超重症大動脈弁狭窄症と有意な冠動脈狭窄が指摘された。術前血行動態や心不全歴などから検討し，機能予後改善や死亡率減少のため骨折手術を先行させ，その後に経カテーテル大動脈弁置換術と経皮的冠動脈形成術を行い独歩退院できた。

　We provide the case details of an 88-year-old woman who was scheduled to undergo osteosynthesis for a right femoral trochanteric fracture. In the preoperative evaluation for osteosynthesis, she was diagnosed with both asymptomatic but very severe aortic valve stenosis and coronary artery stenosis. Considering the preoperative hemodynamics and the patient’s history of heart failure, the osteosynthesis was conducted before the patient underwent transcatheter aortic valve implantation and percutaneous coronary intervention for the improvement of her functional prognosis and to lessen her mortality risk. No adverse events occurred, and the patient was ambulatory when she was discharged. The anesthetic management for her intertrochanteric fracture is also explained.