重症僧帽弁閉鎖不全症に併存した弓部大動脈内血栓症に対して弓部大動脈人工血管置換術を施行した1例
症例は74歳男性．労作時の息切れを主訴に近医から心不全精査目的で当院に紹介となった．心エコーで重症僧帽弁閉鎖不全症を認め，さらにCTで弓部大動脈内血栓症と冠動脈狭窄症を認めたため，塞栓症のリスクを考慮して同日緊急手術を施行した．手術はfenestrated frozen elephant trunk法を併用した弓部大動脈人工血管置換術と僧帽弁形成術および冠動脈バイパス術を施行した．血液検査では凝固異常をきたしうる基礎疾患はなかった．術後合併症はなく経過は良好で術後19日目に独歩で自宅退院となった．術後1年を経過したが血栓症や心不全の再発は認めていない．本症例のように重症僧帽弁閉鎖不全症に大動脈...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 53; no. 3; pp. 131 - 135 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本心臓血管外科学会
15.05.2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.53.131 |
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| Abstract | 症例は74歳男性．労作時の息切れを主訴に近医から心不全精査目的で当院に紹介となった．心エコーで重症僧帽弁閉鎖不全症を認め，さらにCTで弓部大動脈内血栓症と冠動脈狭窄症を認めたため，塞栓症のリスクを考慮して同日緊急手術を施行した．手術はfenestrated frozen elephant trunk法を併用した弓部大動脈人工血管置換術と僧帽弁形成術および冠動脈バイパス術を施行した．血液検査では凝固異常をきたしうる基礎疾患はなかった．術後合併症はなく経過は良好で術後19日目に独歩で自宅退院となった．術後1年を経過したが血栓症や心不全の再発は認めていない．本症例のように重症僧帽弁閉鎖不全症に大動脈内血栓症を合併した例は稀である．血液凝固異常をきたしうる基礎疾患はなくとも大動脈内に血栓を形成する場合があることを念頭に診療を行うことが肝要であると考えられた．文献的考察を加えて報告する． |
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| AbstractList | 症例は74歳男性．労作時の息切れを主訴に近医から心不全精査目的で当院に紹介となった．心エコーで重症僧帽弁閉鎖不全症を認め，さらにCTで弓部大動脈内血栓症と冠動脈狭窄症を認めたため，塞栓症のリスクを考慮して同日緊急手術を施行した．手術はfenestrated frozen elephant trunk法を併用した弓部大動脈人工血管置換術と僧帽弁形成術および冠動脈バイパス術を施行した．血液検査では凝固異常をきたしうる基礎疾患はなかった．術後合併症はなく経過は良好で術後19日目に独歩で自宅退院となった．術後1年を経過したが血栓症や心不全の再発は認めていない．本症例のように重症僧帽弁閉鎖不全症に大動脈内血栓症を合併した例は稀である．血液凝固異常をきたしうる基礎疾患はなくとも大動脈内に血栓を形成する場合があることを念頭に診療を行うことが肝要であると考えられた．文献的考察を加えて報告する． |
| Author | 山﨑, 琢磨 田辺, 友暁 栃木, 秀一 齋藤, 真人 丁, 毅文 建部, 祥 |
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| References | 3) Pagni S, Trivedi J, Ganzel BL et al. Thoracic aortic mobile thrombus: is there a role for early surgical intervention?. Ann Thorac Surg 2011; 91: 1875-81. 14) Okamura H, Arakawa M, Takeuchi T et al. The fenestrated frozen elephant trunk technique for acute type A aortic dissection. J Thorac Cardiovasc Surg 2018; 156: e75-7. 5) Tabata S, Ito T, Hayashi D. Successful non-operative treatment of ischemic pancreatitis due to thromboembolism of the gastroduodenal artery: a case report. J Jpn Panc Soc 2022; 37: 274-80. 8) Uehara H, Hori T, Uchiyama M et al. A case of ascending aorta mural thrombus under direct oral anticoagulant therapy for atrial fibrillation. Heart 2021; 53: 853-7. 13) Laperche T, Laurian C, Roudaut R et al. Mobile thromboses of the aortic arch without aortic debris. A transesophageal echocardiographic finding associated with unexplained arterial embolism. The Filiale Echocardiographie de la Société Française de Cardiologie. Circulation 1997; 96: 288-94. 9) Kawaguchi S, Miyano Y, Goto S et al. A mobile thrombus in the aortic arch. Jpn J Cardiovasc Surg 2021; 50: 57-60. 12) Ando J, Yamamoto K. Flow detection and calcium signalling in vascular endothelial cells. Cardiovasc Res 2013; 99: 260-8. 10) Kasa K, Shinozaki S, Watanabe S. Mural thrombosis in the ascending aorta revealed by cerebral infarction: a case report. Jpn J Cardiovasc Surg 2020; 49: 300-4. 11) Mizuno Y, Kumada Y, Masuda A et al. Floating thrombus originating from the ligamentum arteriosus in the descending aorta as a cause of superior mesenteric arterial embolism. JJAAM 2019; 30: 175-81. 15) Okamura H, Kitada Y, Miyagawa A et al. Clinical outcomes of a fenestrated frozen elephant trunk technique for acute type A aortic dissection. Eur J Cardiothorac Surg 2021; 59: 765-72. 2) Bowdish ME, Weaver FA, Liebman HA et al. Anticoagulation is an effective treatment for aortic mural thrombi. J Vasc Surg 2002; 36: 713-9. 4) Jaworski L, Fijalkowski M, Rogowski J. Giant thrombus in ascending aorta and aortic arch. J Thorac Cardiovasc Surg 2013; 145: 1668-9. 1) Machleder H I, Takiff H, Lois J F et al. Aortic mural thrombus: an occult source of arterial thromboembolism. J Vasc Surg 1986; 4: 473-8. 7) Tauchi Y, Mitsui H, Miura T. A case of thrombectomy performed by supuraclavicular incision for the patient with right subclavian artery thromboembolism. Jpn J Vas Surg 2021; 30: 109-12. 6) Tashima T, Sako H, Takayama T et al. A case of endoscopic-assisted thrombectomy of the descending aorta through a small left intercostal thoracotomy. Jpn J Cardiovasc Surg 2021; 50: 401-4. |
| References_xml | – reference: 7) Tauchi Y, Mitsui H, Miura T. A case of thrombectomy performed by supuraclavicular incision for the patient with right subclavian artery thromboembolism. Jpn J Vas Surg 2021; 30: 109-12. – reference: 13) Laperche T, Laurian C, Roudaut R et al. Mobile thromboses of the aortic arch without aortic debris. A transesophageal echocardiographic finding associated with unexplained arterial embolism. The Filiale Echocardiographie de la Société Française de Cardiologie. Circulation 1997; 96: 288-94. – reference: 8) Uehara H, Hori T, Uchiyama M et al. A case of ascending aorta mural thrombus under direct oral anticoagulant therapy for atrial fibrillation. Heart 2021; 53: 853-7. – reference: 5) Tabata S, Ito T, Hayashi D. Successful non-operative treatment of ischemic pancreatitis due to thromboembolism of the gastroduodenal artery: a case report. J Jpn Panc Soc 2022; 37: 274-80. – reference: 10) Kasa K, Shinozaki S, Watanabe S. Mural thrombosis in the ascending aorta revealed by cerebral infarction: a case report. Jpn J Cardiovasc Surg 2020; 49: 300-4. – reference: 14) Okamura H, Arakawa M, Takeuchi T et al. The fenestrated frozen elephant trunk technique for acute type A aortic dissection. J Thorac Cardiovasc Surg 2018; 156: e75-7. – reference: 12) Ando J, Yamamoto K. Flow detection and calcium signalling in vascular endothelial cells. Cardiovasc Res 2013; 99: 260-8. – reference: 15) Okamura H, Kitada Y, Miyagawa A et al. Clinical outcomes of a fenestrated frozen elephant trunk technique for acute type A aortic dissection. Eur J Cardiothorac Surg 2021; 59: 765-72. – reference: 1) Machleder H I, Takiff H, Lois J F et al. Aortic mural thrombus: an occult source of arterial thromboembolism. J Vasc Surg 1986; 4: 473-8. – reference: 4) Jaworski L, Fijalkowski M, Rogowski J. Giant thrombus in ascending aorta and aortic arch. J Thorac Cardiovasc Surg 2013; 145: 1668-9. – reference: 6) Tashima T, Sako H, Takayama T et al. A case of endoscopic-assisted thrombectomy of the descending aorta through a small left intercostal thoracotomy. Jpn J Cardiovasc Surg 2021; 50: 401-4. – reference: 9) Kawaguchi S, Miyano Y, Goto S et al. A mobile thrombus in the aortic arch. Jpn J Cardiovasc Surg 2021; 50: 57-60. – reference: 3) Pagni S, Trivedi J, Ganzel BL et al. Thoracic aortic mobile thrombus: is there a role for early surgical intervention?. Ann Thorac Surg 2011; 91: 1875-81. – reference: 11) Mizuno Y, Kumada Y, Masuda A et al. Floating thrombus originating from the ligamentum arteriosus in the descending aorta as a cause of superior mesenteric arterial embolism. JJAAM 2019; 30: 175-81. – reference: 2) Bowdish ME, Weaver FA, Liebman HA et al. Anticoagulation is an effective treatment for aortic mural thrombi. J Vasc Surg 2002; 36: 713-9. |
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| Snippet | 症例は74歳男性．労作時の息切れを主訴に近医から心不全精査目的で当院に紹介となった．心エコーで重症僧帽弁閉鎖不全症を認め，さらにCTで弓部大動脈内血栓症と冠動脈狭窄症を認めたため，塞栓症のリスクを考慮して同日緊急手術を施行した．手術はfenestrated frozen elephant... |
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| SubjectTerms | fenestrated frozen elephant trunk法 僧帽弁閉鎖不全症 大動脈内血栓症 |
| Title | 重症僧帽弁閉鎖不全症に併存した弓部大動脈内血栓症に対して弓部大動脈人工血管置換術を施行した1例 |
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