大動脈基部部分形成術中の大動脈解離に対する二期的修復術の1例

Aortic Root Partial Reconstruction Combined with Intraoperative Aortic Dissection：Report of a Case

はじめに　囊状動脈瘤を呈するValsalva洞動脈瘤に対して，大動脈基部形成術中に遮断鉗子によるStanford A型大動脈解離を起こした症例を経験した．長時間の大動脈遮断による負担を避けるため，人工血管による大動脈のラッピング術を行い，二期的に上行大動脈置換術を行って救命した．

A 73-year-old woman with Valsalva aneurysm and mitral regurgitation was introduced to our department. We performed combined operation including aortic root partial repair and mitral valve repair. After wenning from cardiopulmonary bypass, intraoperative aortic dissection was confirmed by transesophageal echocardiography from the ascending aorta to the descending aorta, entry was near to proximal anastomosis line of the ascending aorta. To avoid heart failure, the ascending aorta wrapping by prothesis graft was performed to protect from urgent rupture postoperative at first stage. According to contrast computed tomography （CT） findings, location of entry was correspond with aortic clamping. We performed partial aortic replacement including innominate artery reconstruction for her at fourth day postoperative for treating aortic dissection at second stage. Postoperative course was uneventful.