急性 A 型大動脈解離術後の大動脈基部瘤右房穿破の1救命例  [in Japanese] A Case of Aorto-Right Atrial Fistula Following Acute Type A Dissection Repair  [in Japanese]

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Author(s)

    • 焼田 康紀 Yakita Yasunori
    • 船橋市立医療センター心臓血管センター心臓血管外科 Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center
    • 茂木 健司 Mogi Kenji
    • 船橋市立医療センター心臓血管センター心臓血管外科 Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center
    • 松浦 馨 Matsuura Kaoru
    • 船橋市立医療センター心臓血管センター心臓血管外科 Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center
    • 櫻井 学 Sakurai Manabu
    • 船橋市立医療センター心臓血管センター心臓血管外科 Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center
    • 小笠原 尚志 Ogasawara Takashi
    • 船橋市立医療センター心臓血管センター心臓血管外科 Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center
    • 高原 善治 Takahara Yoshiharu
    • 船橋市立医療センター心臓血管センター心臓血管外科 Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center

Abstract

症例は67歳女性.9年前にStanford A型急性大動脈解離に対して当院で上行弓部大動脈置換術を受け,外来通院中であった.半年前から胸部違和感,4日前に胸痛を自覚し,胸痛の増強,動悸,冷感を主訴に当院救急外来を受診した.胸骨右縁で連続性雑音を聴取し,造影CTで大動脈基部に最大径60 mmの仮性動脈瘤を認めた.心臓超音波検査で動脈瘤と右房に交通を認めた.緊急手術を施行し,大動脈右房瘻閉鎖,上行大動脈人工血管再置換術を施行した.術後経過は良好で,第14病日に独歩退院した.大動脈基部仮性瘤が右房に穿破した稀な症例を経験したので報告する.

Patients with an aortic root pseudoaneurysm communicating to the right atrium are rare. A 67-year-old woman underwent ascending aorta and total aortic arch replacement for acute type A aortic dissection at our institute 9 years prior to the current presentation. She was transported to our emergency department with complaints of chest pain, palpitations, and cold sensation. A continuous murmur was heard at the right sternal margin. Contrast-enhanced computed tomography (CT) and ultrasonic cardiography showed a huge pseudoaneurysm at the proximal anastomotic site and an aorto-right atrial fistula. Ascending aortic replacement with concomitant direct closure of the fistula was successfully performed. The patient was discharged in good condition on the 14th postoperative day. Careful follow-up with CT is important after acute type A aortic dissection repair.

Journal

  • Japanese Journal of Cardiovascular Surgery

    Japanese Journal of Cardiovascular Surgery 44(1), 56-58, 2015

    The Japanese Society for Cardiovascular Surgery

Codes

  • NII Article ID (NAID)
    130004887234
  • Text Lang
    JPN
  • ISSN
    0285-1474
  • Data Source
    J-STAGE 
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