右鎖骨下動脈起始異常を伴ったStanford A型急性大動脈解離の1例

Stanford Type A Acute Aortic Dissection Accompanying Aberrant Right Subclavian Artery：Report of a Case

はじめに　右鎖骨下動脈起始異常は大動脈弓部形成時期に生じる先天性分岐異常であり，その頻度は1.4％である1，2）．Kommerell憩室の20～60％に右鎖骨下動脈起始異常を合併する3）．われわれは，Kommerell憩室に右鎖骨下動脈起始異常を合併したStanford A型急性大動脈解離を経験したので，若干の文献的考察を含めて報告する．

A 64-year-old man was transferred to our hospital due to a diagnosis of Stanford type A acute aortic dissection complicated by cardiac tamponade. He was in shock status as well. Careful inspection of contrast-enhanced computed tomography revealed Kommerell’s diverticulum with the aberrant right subclavian artery running behind the esophagus. The artery connected to the right axillary artery. The left vertebral artery was separately branched from the aortic arch. Primary entry was not detected on the preoperative computed tomography （CT）. Left ventricular function was preserved by transthoracic echocardiography. At emergency surgery, total aortic arch replacement with reconstruction of the right axillary artery, both carotid arteries, and the left subclavian artery along with the left vertebral artery was successfully performed. The aberrant right subclavian artery was ligated at the origin. Kommerell’s diverticulum was completely excluded. Postoperative contrast-enhanced CT showed the patency of all reconstructed arteries. Although he suffered from acute cholecystitis and persistent bilateral pleural effusion, he was discharged in a good condition.