大動脈基部残存偽腔拡大により人工血管屈曲および溶血性貧血をきたした1例

Graft Kink with Hemolytic Anemia Caused by Enlargement of the Residual False Lumen in the Aortic Root：Report of a Case

はじめに　胸部大動脈手術後の溶血性貧血はまれである．われわれは，Stanford A型急性大動脈解離に対する上行大動脈置換術後に残存中枢側偽腔の拡大で人工血管が屈曲し，術後2年6ヵ月で溶血性貧血をきたし，術後4年で再手術を要した1例を経験したので報告する．

A 67-year-old male underwent ascending aortic replacement for Stanford type A acute aortic dissection four years ago. Residual false lumen in the aortic root and mild to moderate aortic regurgitation were noted postoperatively. Two and a half years later, he presented with hemolytic anemia and shortness of breath. Computed tomography （CT） revealed aneurysmal aortic root and severely kinked vascular prosthesis, and echocardiography showed severe aortic regurgitation. It was considered that the proximal residual false lumen gradually enlarged, and the graft was pushed up distally and kinked, resulting in hemolytic anemia. Surgical treatment was indicated because of deteriorating shortness of breath due to hemolytic anemia （Hb 6.7 g/dl, LDH 1,528 U/l） and aortic regurgitation. Aortic root replacement was successfully performed and hemolytic anemia improved immediately after surgery.