Kuroda Yoshinori, Uchida Tetsuro, Hamasaki Azumi, Yamashita Atsushi, Mizumoto Masahiro, Hayashi Jun, Ishizawa Ai, Akabane Kentaro, Sadahiro Mitsuaki
Second Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan.
Kyobu Geka. 2018 Feb;71(2):111-114.
A 45 year-old-man who had undergone ventricular septal defect repair during childhood presented with hoarseness. He was diagnosed as having a distal aortic arch aneurysm by using computed tomography, and was referred to our hospital for surgical treatment. The operation was performed via a 4th intercostal thoracotomy in the right lateral position. The aortic aneurysm occupied the upper pleural cavity. The aortic arch was pressed up by the aortic aneurysm, so visual identification and clamping of the proximal aorta and the left subclavian artery were extremely difficult. Extracorporeal circulation was established via the right femoral artery and vein. Aneurysmal resection and graft replacement were performed using the open proximal method and retrograde cerebral circulation. The aneurysmal wall and proximal aorta were fragile and the proximal aorta was narrow, although the distal aorta was normal. The difference in diameters between the proximal and distal aorta suggested the presence of coarctation of the aorta.
一名45岁男性，童年时曾接受室间隔缺损修复手术，现出现声音嘶哑。通过计算机断层扫描诊断为远端主动脉弓动脉瘤，并转诊至我院接受手术治疗。手术在右侧卧位经第4肋间开胸进行。主动脉瘤占据上胸腔。主动脉弓被主动脉瘤向上挤压，因此近端主动脉和左锁骨下动脉的视觉识别和夹闭极其困难。通过右股动静脉建立体外循环。采用开放近端法和逆行脑循环进行动脉瘤切除和人工血管置换。动脉瘤壁和近端主动脉脆弱，近端主动脉狭窄，尽管远端主动脉正常。近端和远端主动脉直径的差异提示存在主动脉缩窄。
