Takami Hiroshi, Doki Yuichiro, Yachiku Kenji, Takeuchi Daisuke, Arisawa Jun, Kobayashi Tohru
Department of Cardiovascular Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
Jpn J Thorac Cardiovasc Surg. 2003 Dec;51(12):685-7. doi: 10.1007/s11748-003-0012-9.
A 67-year-old woman with congestive heart failure due to aortic stenosis and regurgitation needed aortic valve replacement. She had undergone right radical mastectomy 23 years before, and total thoracic esophagectomy with retrosternal gastric tube reconstruction 11 years before. Plain computed tomography showed coincident porcelain aorta. Aortic valve replacement was performed through a median sternotomy approach. Blunt dissection on anterior and right side of the gastric tube could be done with minimal injury, and the heart was exposed as in usual cardiac surgery. Preoperative multi-detector computed tomography revealed inhomogeneous and patchy distribution of calcification in the ascending aorta, and was helpful to decide aortotomy site. Aortic valve replacement was done and aortotomy was closed with felt strip buttressed running suture. Postoperative course was uneventful.
一名67岁女性因主动脉瓣狭窄和反流导致充血性心力衰竭，需要进行主动脉瓣置换术。她23年前接受了右乳癌根治术，11年前接受了全胸段食管切除术并采用胸骨后胃管重建术。普通计算机断层扫描显示主动脉呈巧合性瓷化。通过正中胸骨切开术进行主动脉瓣置换。在胃管前方和右侧进行钝性分离时损伤最小，心脏暴露方式与常规心脏手术相同。术前多排计算机断层扫描显示升主动脉钙化分布不均匀且呈斑片状，有助于确定主动脉切开部位。进行了主动脉瓣置换，并用带垫片连续缝合关闭主动脉切开处。术后过程顺利。
