Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
Pediatric Cardiology and Cardiac Surgery 38(2): 140-144 (2022)
doi:10.9794/jspccs.38.140

症例報告Case Report

大動脈縮窄に対する小児期subclavian flap法修復術後の大動脈瘤成人期の再手術2例Late Aortic Aneurysm Following Subclavian Flap Aortoplasty for Coarctation of the Aorta: A Report of Two Adult Cases

1兵庫県立尼崎総合医療センター心臓血管外科Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center ◇ Hyogo, Japan

2兵庫県立尼崎総合医療センター小児循環器内科Department of Pediatric Cardiology, Hyogo Prefectural Amagasaki General Medical Center ◇ Hyogo, Japan

受付日:2021年10月26日Received: October 26, 2021
受理日:2022年4月27日Accepted: April 27, 2022
発行日:2022年5月1日Published: May 1, 2022
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大動脈縮窄(coarctation of the aorta: CoA)に対するパッチ形成術後の合併症として大動脈瘤の頻度は多いが,鎖骨下動脈フラップ(subclavian flap aortoplasty: SCF)法術後の大動脈瘤の報告は少ない.CoAに対するSCF法術後の成人期にCoA修復部の大動脈瘤に対する再手術を2例経験した.症例1は,26歳男性で,3歳時にCoAに対してSCF法での修復術を施行した.経過観察中にSCF部の遠位に紡錘状の大動脈瘤を認めた.胸骨正中切開,超低体温循環停止,逆行性脳灌流下に人工血管置換術を行った.瘤はSCF部自体で,中膜嚢胞壊死を認めた.術後15年,再発はなく経過良好である.症例2は,34歳女性で,6歳時にCoAに対してSCF法での修復術を施行した.経過観察中にSCF部の遠位小弯側に嚢状の大動脈瘤を認めた.左側開胸,下半身部分体外循環下に,人工血管置換術を行った.瘤は動脈管組織と思われた.術後14年,再発はなく経過良好である.SCF法術後の大動脈瘤は注意すべき合併症であり,観察の継続が必要である.

Late aortic aneurysm is a rare complication of subclavian flap aortoplasty (SCF) for coarctation of the aorta (CoA). Here, we describe the cases of two adult patients with late aortic aneurysm after SCF. The first patient was a 26-year-old man who underwent SCF for a simple CoA at 3 years old. He had a fusiform type of aortic aneurysm located at the site of SCF. Aortic graft replacement was successfully performed under deep hypothermic circulatory arrest using the retrograde cerebral perfusion technique through a median sternotomy. The second patient was a 34-year-old woman who underwent SCF for a simple CoA using SCF at 6 years old. She had a saccular type of aortic aneurysm in the distal lesser curvature wall of the SCF. Aortic graft replacement was successfully performed using the partial bypass technique through a left thoracotomy. The patients were stable without late complications postoperatively after 14 and 13 years, respectively. Long-term follow-up is required for late aortic aneurysms after SCF.

Key words: coarctation of the aorta; subclavian flap aortoplasty; adult congenital heart disease; aortic aneurysm; reoperation

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This page was last modified on 2022-08-03T14:01:25.000+09:00


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