成人型大動脈縮窄症に対する無輸血での下行置換術―医用画像ビューワを用いた手術戦略

Surgical Replacement of Descending Aorta for Adult Aortic Coarctation by Using Three-dimensional Computer Graphics Reconstruction

成人型大動脈縮窄症は成人先天性心疾患の約5％を占め，高血圧を契機として発見されることが多い1，2）．下肢虚血症状や心不全を呈する未治療例の予後は不良であり，一般的に外科的介入が選択される2）．人工血管置換術は標準的な術式であるが，術中および術後出血に伴う輸血使用や再開胸手術を必要とした症例が報告されている3）．

Aortic coarctation is diagnosed in approximately 5％ of adult patients with congenital heart disease and is commonly diagnosed through the close examination of hypertension. Various surgical strategies for adult coarctation have been recently reported. Generally, aortic replacement may require blood transfusion in case of injury of the well-developed collateral vessels. Therefore, in order to secure an operative safety, we preoperatively used a medical image viewer to identify the abnormal vessels by three-dimensional computer graphics （3DCG） reconstruction. A 34-year-old male patient was referred to our hospital with hypertension and low ankle-brachial pressure index （ABI）. Chest computed tomography （CT） scan showed aortic coarctation and development of abnormal collateral vessels. Descending aorta was replaced via a left third-fourth intercostal thoracotomy under partial extracorporeal circulation. As the image viewer depicted, anatomical abnormality of the collateral vessels was identified precisely, and surgically treated without any injury. The patient was discharged 10 days postoperatively without transfusion and with a normalized ABI.