Naganuma Junichi, Ninomiya Mikio, Miyairi Takeshi, Kotsuka Yutaka, Takamoto Shinichi
Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Jpn J Thorac Cardiovasc Surg. 2002 Jul;50(7):298-301. doi: 10.1007/BF03032299.
A 74-year-old man with an aortic arch aneurysm and a chronic type IIIb aortic dissection underwent total aortic arch repair without cerebral or cardiac ischemia. After confirming no atheromatous change in the ascending aortic wall, a custom-designed 4-limbed graft, prepared for both arterial return of cardiopulmonary bypass and reconstruction of the arch vessels, was anastomosed onto the right side of the ascending aorta. The 3 arch vessels were then bypassed sequentially during systemic cooling and monitoring cerebral perfusion with near-infrared oxymetry. After aortic cross-clamping, a stent graft was inserted into the distal arch from the distal ascending aorta, maintaining cerebral and cardiac perfusion. This procedure is indicated especially in a high-risk patient who has an aortic arch aneurysm without severe atheromatous change in the ascending aorta and the arch vessels.
一名患有主动脉弓动脉瘤和慢性IIIb型主动脉夹层的74岁男性接受了全主动脉弓修复术，未出现脑或心脏缺血情况。在确认升主动脉壁无动脉粥样硬化改变后，将为体外循环的动脉回血和弓部血管重建而定制设计的四分支移植物吻合到升主动脉右侧。然后在全身降温并通过近红外血氧饱和度监测脑灌注的过程中，依次绕过三根弓部血管。在主动脉阻断后，从升主动脉远端向远端弓部插入覆膜支架，维持脑和心脏灌注。该手术尤其适用于患有主动脉弓动脉瘤且升主动脉和弓部血管无严重动脉粥样硬化改变的高危患者。
