| Japanese |
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| Title | 胸腹部大動脈瘤手術における循環制御と術式 |
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| Subtitle | 講座 |
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| Authors | 山田崇之 |
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| Organization | 獨協医科大学越谷病院心臓血管外科 |
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| Journal | 循環制御 |
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| Volume | 18 |
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| Number | 3 |
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| Page | 402-408 |
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| Year/Month | 1997/ |
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| Article | 報告 |
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| Publisher | 日本循環制御医学会 |
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| Abstract | 大動脈遮断を必要とする胸腹部大動脈瘤手術においては術中臓器循環維持のために体外循環あるいは低体温によって代謝を下げるなど術中の循環制御は手術成績を左右する重要な因子となる. 動脈瘤の発生部位, 範囲あるいは瘤の性状によって選択すべき補助手段, 術式も異なる. 心臓から駆出された血流の順序を追って部位, 特徴, 選択すべき補助手段, 手術術式などについて検討した. 「上行大動脈瘤+大動脈弁閉鎖不全」単純な大動脈弁はさておいて問題となるのはMarfan症候群の上行大動脈瘤+大動脈弁閉鎖不全を伴うAnnuloaortic ectasiaである. 本疾患では上行大動脈人工血管置換, 大動脈弁置換そして冠動脈再建が必要となる. Annuloaortic ectasiaに対しては大動脈基部を残して瘤切除+人工血管置換を行うWheat手術1)が1964年に発表されたがDeBakeyら2)はWheat手術後数年を経過して大動脈起始部の遺残大動脈から大きな瘤発生を見, 再手術を余儀なくされた. |
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| Practice | 基礎医学・関連科学 |
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| English |
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| Title | Circulation Control and Surgery for the Thoraco-abdominal Aneurysm Repair |
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| Subtitle | |
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| Authors | Takashi Yamada |
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| Organization | Department of Cardiovascular and Thoracic Surgery, Dokkyo University Koshigaya Hospital |
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| Journal | Circulation Control |
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| Volume | 18 |
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| Number | 3 |
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| Page | 402-408 |
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| Year/Month | 1997/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | For the treatment of annuloaotric ectasia with aortic regurgitation, the Bentall operation predominates. Certain problems remain unsolved with regard to the reconstruction of coronary artery, control of bleeding from the anastomotic suture line, reconstruction of low take-off coronary artery and fragile aortic intima. Interposition graft technique (Piehler-Pluth) affords tension-less operative field. In the surgery of arch aneurysm, protection of brain during aortic clamping is crucial. Each branch receives approximately 5% of cardiac output. During separate cerebral perfusion, this amount of blood should be infused. Hypothermia reduces metabolic rate and hence could reduce the blood flow according to the body temperature. Approximately 10% of optimum cardiopulmonary bypass flow, i.e. 150ml/min for BSA of 1.3m2 and 230ml/min for 2.0m2, should be infused to each carotid artery. Paraplegia is the most devasting complication of the thoracoabdominal aortic repair caused primarily by the interruption of blood flow to the spinal cord. Flow to the spinal cord was maintained by the partial bypass during the anastomosis of graft to the distal arch and then by the intra-aneurysmal flow during the reconstruction of splanchnic arteries. Artery to the spinal cord (Adamkiewicz artery) was reconstructed in the level between L5 and T5. Spinal cord blood flow was thus maintained during the important surgical procedure. Interruption of flow to the spinal cord was limited only during its reconstruction. The 3-channeled aortic dissection is reported rare. However, 3 cases were operated upon in our hospital. Fenestration of dissected intima provides recovery of splanchnic flow and function of affected organs and made possible to place the patient on bypass. To prevent rupture of the aorta and to reanimate the hypoperfused visceral organs, repair of entire thoracoabdominal aorta and artery to the spinal cord enhances the chance of survival. |
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| Practice | Basic medicine |
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