Higashino Akihiro, Taketani Tsuyoshi, Suzuki Hiroyuki, Miura Sumio, Ohno Takayuki
Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, JPN.
Cardiovascular Surgery, Okayama University, Okayama, JPN.
Cureus. 2022 Jun 17;14(6):e26031. doi: 10.7759/cureus.26031. eCollection 2022 Jun.
Coronary button aneurysm is a well-known complication of aortic root surgery, especially in patients with Marfan syndrome. We present a case of a giant left coronary button aneurysm that occurred 20 years after an aortic root remodeling procedure was performed. A 32-year-old man with Marfan syndrome underwent the aortic root remodeling procedure for annuloaortic ectasia. Thirteen years later, an aortic aneurysm with chronic aortic dissection was diagnosed, and partial aortic arch replacement was performed. Twenty years after the first procedure, a 73-mm left coronary button aneurysm was observed. Due to dense adhesions from repeated surgeries, we approached the aneurysm through the artificial graft lumen, and the coronary artery was successfully reconstructed using Piehler's technique. When performing aortic root surgery for Marfan syndrome, the risk of coronary artery button aneurysm formation should be considered. Once an aneurysm is formed, a surgical strategy that assumes dense adhesions is essential.
冠状动脉纽扣状动脉瘤是主动脉根部手术的一种常见并发症，尤其是在马凡综合征患者中。我们报告一例巨大的左冠状动脉纽扣状动脉瘤病例，该动脉瘤在主动脉根部重塑手术后20年出现。一名32岁的马凡综合征男性因主动脉瓣环扩张接受了主动脉根部重塑手术。13年后，诊断出患有慢性主动脉夹层的主动脉瘤，并进行了部分主动脉弓置换术。首次手术后20年，观察到一个73毫米的左冠状动脉纽扣状动脉瘤。由于多次手术导致的致密粘连，我们通过人工移植物腔接近动脉瘤，并使用皮勒技术成功重建了冠状动脉。在为马凡综合征患者进行主动脉根部手术时，应考虑冠状动脉纽扣状动脉瘤形成的风险。一旦形成动脉瘤，采取应对致密粘连的手术策略至关重要。
