Kido M, Kawaguchi H, Ninomiya H, Osako M, Otani H, Imamura H
Department of Thoracic and Cardiovascular Surgery, Kansai Medical University, Osaka, Japan.
Jpn J Thorac Cardiovasc Surg. 1998 Oct;46(10):1024-7. doi: 10.1007/BF03217867.
Aneurysm of the diverticulum of the ductus arteriosus in the adult is rare. One stage operation for aneurysm of the diverticulum of the ductus arteriosis and coronary artery bypass grafting (CABG) is reported. A 61-year-old man was admitted for diagnosis of thoracic aneurysm on chest X-ray and CT. Chest CT scan showed an aneurysm above the left main pulmonary artery. An aortography showed the left vertebral artery originated directly from the aortic arch and a saccular aneurysm arising from the aortic isthmus and lesser curvature of the aortic arch. Coronary arteriography showed 75% stenosis at the right coronary artery (seg. #1) and 75% stenosis at the left anterior descending artery. Operation was performed through a median sternotomy. The aneurysm of 6 to 3 cm was located between the aortic isthmus and left pulmonary artery. Ascending aorta and right atrium were used to institute cardiopulmonary bypass (CPB). CABG (LITA to #7, SVG to #4 PD) was performed. Arterial cannulation was then switched to the left femoral artery. The proximal aorta was cross-clamped between the left vertebral artery and the left subclavian artery under the partial CPB, and the distal aorta was occluded with a occulusive balloon catheter via the right femoral artery. The selective left axillar artery cannulation was performed to perfuse LITA. The aneurysm was resected and closed with a patch. His post-operative course was uneventful.
成人动脉导管憩室动脉瘤罕见。本文报道了一例动脉导管憩室动脉瘤一期手术联合冠状动脉旁路移植术（CABG）的病例。一名61岁男性因胸部X线和CT检查诊断为胸主动脉瘤入院。胸部CT扫描显示左主肺动脉上方有一个动脉瘤。主动脉造影显示左椎动脉直接起源于主动脉弓，主动脉峡部和主动脉弓小弯处有一个囊状动脉瘤。冠状动脉造影显示右冠状动脉（第1段）狭窄75%，左前降支狭窄75%。通过正中胸骨切开术进行手术。6×3cm的动脉瘤位于主动脉峡部和左肺动脉之间。采用升主动脉和右心房建立体外循环（CPB）。进行了冠状动脉旁路移植术（左内乳动脉至第7支，大隐静脉至第4对角支）。然后将动脉插管改为左股动脉。在部分体外循环下，在左椎动脉和左锁骨下动脉之间夹闭主动脉近端，通过右股动脉用封堵球囊导管封堵主动脉远端。进行选择性左腋动脉插管以灌注左内乳动脉。切除动脉瘤并用补片封闭。患者术后恢复顺利。
