大動脈スイッチ術後の左冠状動脈主幹部高度狭窄に対する入口部形成

Left Main Trunk Orifice Reconstruction Using Aortic flap and Autologous Pulmonary Arterial Patch for Severe Left Main Trunk Stenosis After Arterial Switch Operation

近年，大動脈スイッチ術（ASO）の手術成績は安定しているが，8〜10％は遠隔期に冠状動脈の狭窄・閉塞病変を認めると報告されている1）．冠状動脈病変の修復法については，冠状動脈バイパス手術の良好な結果の報告はあるが2），長期経過観察の報告はなく議論の余地がある．われわれは，ASO術後の左冠状動脈主幹部狭窄に対して大動脈フラップおよび肺動脈壁パッチによる入口部形成を行った症例を報告する．

A 6-year-old boy with left main trunk （LMT） stenosis, who had undergone arterial switch operation （ASO） for transposition of the great arteries （TGA） before 6 years, underwent LMT orifice reconstruction. Coronary angiography showed severe stenosis of LMT, already when he was hospitalized with heart failure after 3 months of ASO. He was stable with oral treatment, therefore we performed the LMT reconstruction, before starting school, in terms of the risk of coronary ischemic event. We reconstructed the LMT ostium using an aortic flap and autologous pulmonary arterial patch. The postoperative computed tomography showed neither stenosis nor kinking at the repair site of LMT. He remains asymptomatic for over 6 months. We have reported that this method is effective to repair coronary artery anomalies （CAAs）, since using an aortic flap. We could form a coronary artery floor, which is affixed to the aortic wall. This method allows us to change the coronary orifice position and the angle, so it is very useful method not for only CAAs, but also for coronary stenosis after ASO.