遠位弓部大動脈瘤肺動脈穿破

We report an extremely rare case of rupture of an aortic arch aneurysm into the pulmonary artery. An 85-year-old man was visited to our hospital for surgical repair of aortic arch aneurysm. After arrived at hospital, we noticed he suffer from severe congestive heart failure. Chest auscultation indicated Levine III/IV continuous heart murmur. Computed tomography revealed aortic arch aneurysm and aortic dissection of ascending aorta. Echocardiography demonstrated an abnormal shunt flow from aortic arch aneurysm into the pulmonary artery. At surgery, total arch replacement and pulmonary artery reconstruction were performed

遠位弓部大動脈瘤肺動脈穿破

We report an extremely rare case of rupture of an aortic arch aneurysm into the pulmonary artery. An 85-year-old man was visited to our hospital for surgical repair of aortic arch aneurysm. After arrived at hospital, we noticed he suffer from severe congestive heart failure. Chest auscultation indicated Levine III/IV continuous heart murmur. Computed tomography revealed aortic arch aneurysm and aortic dissection of ascending aorta. Echocardiography demonstrated an abnormal shunt flow from aortic arch aneurysm into the pulmonary artery. At surgery, total arch replacement and pulmonary artery reconstruction were performed

チアノーゼ性心疾患に対する肺動脈絞扼術

The early and late results of pulmonary artery banding (PAB) for cyanotic heart defects in early infancy were reviewed. Nine patients were divided into two groups : Group F (five patiens) in which Fontan type repairs were expected as definitive repair in the near future ; Group A (four patients) in which anatomical repairs were programmed in the near future. Six patients had a good early postoperative course, and then consisted of three patients of Group A and three patients of Group F. The band circumference, intraoperative pulmonary-to-systemic systolic pressure ratio and arterial oxygen tension after PAB in the good cases of Group A were 20.0±1.7 mm + 1 mm for each kilogram of the infant's weight, 0.52±0.07 and 46.4±11.3 mmHg respectively. These indices in the good cases of Group F were 21.1±1.7 mm + 1 mm for each kilogram of the infant's weight, 0.55±0.02 and 38.8±1.0 mmHg respectively. The standard deviations of every index for PAB in Group F were small. Three patients of Group A have undergone successful total correction. Intraoperative pulmonary-to-systemic systolic pressure ratio of 0.5 as the index of PAB is preferable to Group A. However, only two patient of Group F were waiting for Fontan type definitive repair. For the patient especially in Group F, careful observation and well-timed staged repair with regard to subaortic stenosis and restrictive atrial septal defect and ventricular septal defect are necessary after accurate PAB as mentioned above