Nishioka Akira, Takahashi Kyosuke, Maehara Yasuhiro
Department of Anesthesiology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa, Chiba, Japan.
Department of Anesthesiology and Critical Care, Jichi Medical University Saitama Medical Center, 1-847, Amanumacho, Omiya, Saitama, Japan.
JA Clin Rep. 2021 Jan 4;7(1):2. doi: 10.1186/s40981-020-00404-w.
Idiopathic dilatation of the pulmonary artery (IDPA) is a rare condition in which the pulmonary artery dilates without an obvious cause. Pulmonary artery replacement is indicated in severe cases to prevent serious complications.
A 59-year-old man was diagnosed with an IDPA of 64 mm and Kommerell's diverticulum (aortic aneurysm located at the aberrant left subclavian artery). A computed tomography scan revealed slight compression of the aneurysm to the trachea, although not interfering with airway management. The surgical approach was a median sternotomy, and cardiopulmonary bypass was established through aortic and bicaval cannulations. The perioperative course was uneventful.
To prevent injury to the dilated pulmonary artery, a strategy for cardiopulmonary bypass and a surgical approach should be discussed beforehand. As dilatation of the pulmonary artery is often complicated by anatomic abnormalities, preoperative evaluation should be aimed at appropriate assessments using imaging modalities.
特发性肺动脉扩张（IDPA）是一种罕见的病症，其中肺动脉在无明显原因的情况下发生扩张。严重病例需进行肺动脉置换以预防严重并发症。
一名59岁男性被诊断为肺动脉直径64毫米的IDPA以及Kommerell憩室（位于异常左锁骨下动脉处的主动脉瘤）。计算机断层扫描显示动脉瘤对气管有轻微压迫，尽管不影响气道管理。手术入路为正中胸骨切开术，通过主动脉和双腔静脉插管建立体外循环。围手术期过程顺利。
为防止扩张的肺动脉受到损伤，应提前讨论体外循环策略和手术入路。由于肺动脉扩张常伴有解剖异常，术前评估应以使用影像学检查手段进行适当评估为目标。
