Sato Shunsuke, Matsuda Hitoshi, Fukuda Tetsuya, Domae Keitaro, Iba Yutaka, Tanaka Hiroshi, Sasaki Hiroaki, Ogino Hitoshi
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Ann Vasc Dis. 2012;5(1):61-4. doi: 10.3400/avd.cr.11.00032. Epub 2011 Dec 22.
Three cases with lesions in the right aortic arch (RAA) are presented. For two patients, whose RAA contained a retroesophageal segment, the primary treatment was total arch replacement (TAR) for acute type A dissection or severe arch angulation with thoracic endovascular aneurysm repair (TEVAR) as second-stage surgery. The third patient, who had RAA with mirror image branching, underwent supra-aortic bypass followed by TEVAR. There was no operative mortality, but the condition of two patients who underwent TAR was complicated by bilateral recurrent nerve palsy, which can be critical. The combination of TEVAR and supra-aortic bypass might thus be preferable for patients with RAA.
本文报告了3例右位主动脉弓（RAA）病变的病例。对于2例RAA包含食管后段的患者，主要治疗方法是针对急性A型主动脉夹层或严重的主动脉弓成角进行全弓置换（TAR），并将胸主动脉腔内修复术（TEVAR）作为二期手术。第3例患者有镜像分支的RAA，接受了主动脉弓上旁路手术，随后进行了TEVAR。无手术死亡病例，但2例接受TAR的患者出现双侧喉返神经麻痹并发症，这可能是严重的。因此，对于RAA患者，TEVAR和主动脉弓上旁路手术联合应用可能更可取。
