08症例報告4山内.indd

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1 症例報告 37 急性大動脈解離に対する上行大動脈置換術後の大動脈基部拡張大動脈弁閉鎖不全に対する自己弁温存基部置換術 (remodeling 手術 ) 概要 : mm remodeling 索引用語 : remodeling Remodeling technique for aneurysm of aortic root and moderate aortic valve regurgitation after replacement of ascending aorta for acute aortic dissection : Report of a case Masanobu YAMAUCHI Satoshi KAMIHIRA Tomoki HANADA Kengo NAKAYAMA and Hitoshi OKABAYASHI Abstract Forty-six man was undergone replacement of ascending aorta for acute aortic dissection six years ago. A follow up CT showed an aneurysm of aortic root and also moderate aortic valve regurgitation was detected on echocardiography. We performed valve sparing aortic root replacement remodeling technique. Postoperative course was uneventful. Valve sparing aortic root replacement is fascinate technique for young patients and women who desire to bear children because of unnecessary to anticoagulant therapy. Key words Valve sparing aortic root replacement, Remodeling technique, Aortic dissection, Reoperation はじめに A Bentall remodeling 症例 Department of Cardiovascular Surgery, Shimane Prefectural Central Hospital Department of Cardiovascular Surgery, Iwate Medical University

2 38 mm cm kg / mmhg / SpO TP. g/dl ALB. g/dl GLOB. g/ dl T.Bil. mg/dl ALP U/l AST U/l ALT U/l LDH U/l UN. mg/dl Cre. mg/dl egfr. UA. mg/dl Amy U/L T-Cho mg/ dl TG mg/dl HDL-Cho mg/dl LDL-Cho mg/ dl CK U/l BS mg/dl HbA c. NGSP Na. mmol/l K. mmol/l Cl. mmol/l Ca. mg/dl WBC / l RBC x / l Hb. g/ dl Ht. PLT. x / l PT. INR. APTT.. mg/dl CTR LVDd mm LVDs mm LVEF mm mm mm STJ mm AR vena contracta mm TMF E cm/s A cm/s E/A. PVF S cm/s D cm/s IVC mm mm RCC LCC LCC effective height EH geometric height GH. mm GH RCC. mm NCC. mm LCC. mm EH RCC. mm NCC mm LCC. mm LCC CT mm mm mm

scallop - LCC RCC NCC scallop - central plication RCC NCC

3 remodeling 39 CT mm Axial D-CT GH RCC mm NCC mm LCC mm EH RCC mm NCC mm LCC mm LCC mm AVJ CV- mm - mm mm J mm scallop - LCC RCC NCC scallop - central plication RCC NCC RCC EH mm RCC/NCC RCC/LCC - mm Carrel patch J mm - DC CSL CT CT D-CT

4 40 HE EVG LVDd mm LVDs mm LVEF mm AR BNP pg/ml NYHA 考察 A,., -. - GRF gelatin-resorcinolformaldehyde glue - sino-tubular junction - mm Bentall, mm CT mm reimplantation David remodeling Yacoub - mm Marfan reimplantation remodeling reimplantation remodeling LOS

5 remodeling 41,.. remodeling 結語 remodeling 参考文献 Remodeling,,.,, : ; - Masuda M, Okamura M, Doki Y, et al.: Thoracic and cardiovascular surgery in Japan during : Annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg published online. September. uploads/uploads/files/annual_report_.pdf Accessed - - A.,, : ; -,,, A. ; :,,, A A Bentall. ; :,,, A. ; :,,, A,. ; :,,, Stanford A. ; : - Tanaka M, Kimura N, Yamaguchi A, et al.: In-hospital and Long-Term Results of Surgery for Acute Type A Aortic Dissection: Consecutive Patients. Ann Thorac Cardiovasc Surg ; : -,,, A. ; : -.. CIRCULATION Up-to- Date ; : -,, GEF glue A. ; : - Kobuch R, Hilker M, Rupprecht L, et al.: Late reoperations after repaired acute type A aortic dissection. J Thorac Cardiovasc Surg ; : - Concistre G, Casali G, Santaniello E, et al.: Reoperation After Surgical Correction of Acute Type A Aortic Dissection: Risk Factor Analysis. Ann Thorac Surg ; : - Malvindi PG, van Putte BP, Sonker U, et al.: Reoperation After Acute type A Dissection Repair: A Series of patients. Ann Thorac Surg ; : -

BUN, CRP K mg/ cm, 49.6 kg, BMI /72 mmhg, 92/ Hb 6.7 g/dl PT-INR CT 1 MRI 2a, b T1 T2 T1 MRI

BUN, CRP K mg/ cm, 49.6 kg, BMI /72 mmhg, 92/ Hb 6.7 g/dl PT-INR CT 1 MRI 2a, b T1 T2 T1 MRI 20 2 2015 1 2 3 85 K CT Abstract A case of renal subcapsular hematoma resulting from trigger point injection under excessive effect of anticoagulant YAMANE Tateki, UMEDA Akira and SHIMAO Hitoshi An 85-year-old