大動脈縮窄との関連が示唆された成人紡錘状遠位弓部大動脈瘤の1例

Surgical Experience of Distal Aortic Arch Aneurysm Suspected to be Associated with Pre-existing Coarctation of the Aorta

大動脈瘤は高齢者に多い疾患である．しかしながら結合織疾患や炎症性疾患を伴う若年者でも，まれながら大動脈瘤を発症し手術適応となる．今回，われわれは幼児期に心室中隔欠損症（VSD）の根治術を受け，成人期に診断された紡錘状遠位弓部大動脈瘤に対し手術を施行し，良好な経過を得た．乳児期VSD手術の既往と特異な大動脈瘤の形態から，大動脈縮窄症の関与が疑われた症例であったため，その病因に関して文献的考

A 45 year-old-man who had undergone ventricular septal defect repair during childhood presented with hoarseness. He was diagnosed as having a distal aortic arch aneurysm by using computed tomography, and was referred to our hospital for surgical treatment. The operation was performed via a 4th intercostal thoracotomy in the right lateral position. The aortic aneurysm occupied the upper pleural cavity. The aortic arch was pressed up by the aortic aneurysm, so visual identification and clamping of the proximal aorta and the left subclavian artery were extremely difficult. Extracorporeal circulation was established via the right femoral artery and vein. Aneurysmal resection and graft replacement were performed using the open proximal method and retrograde cerebral circulation. The aneurysmal wall and proximal aorta were fragile and the proximal aorta was narrow, although the distal aorta was normal. The difference in diameters between the proximal and distal aorta suggested the presence of coarctation of the aorta.