5．Shaggy aorta：術式の選択と人工心肺の注意点

Operation for the Shaggy Aorta Syndrome

Shaggy aortaとは，コレステリン結晶を主体とする著明な粥状硬化により，大動脈血管内膜面にびまん性潰瘍性プラークをきたす疾患である．微細なコレステリン結晶が末梢動脈を閉塞することにより，さまざまな病態を呈する疾患をshaggy aorta 症候群と呼ぶ．Shaggy aortaを伴う心臓大血管手術は，塞栓症を含む周術期合併症をきたすリスクが非常に高く，個々の患者に適した治療方針を検討する必要がある．

Although mortality and complication rates of cardiovascular surgery have been reduced, shaggy aorta, which is defined as an extensive severe atherosclerosis of the thoracic and abdominal aorta, is considered a risk factor for perioperative mortality and complications. The shaggy aorta often leads a poor prognosis, and a very high hospital mortality rate when embolization occurs in multiple organs. Therefore, it is important to prevent embolism through detailed evaluation of the disease with preoperative contrast-enhanced computed tomography （CT） scan and intraoperative transesophageal echocardiogram, appropriate individualized treatment decisions, and careful surgical manipulation.