| Japanese |
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| Title | 開存グラフトを有する冠動脈バイパス術後の大動脈弁置換術の経験 |
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| Subtitle | 症例 |
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| Authors | 垣伸明, 今関隆雄, 入江嘉仁, 木山宏, 村井則之, 権重好, 斉藤政仁, 汐口壮一, 内田貴範, 千葉知史, 岡田修一 |
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| Authors(kana) | |
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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 | 22 |
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| Number | 4 |
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| Page | 375-379 |
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| Year/Month | 2001/ |
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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 | 「諸言」開存グラフトを有する冠動脈バイパス術(CABG)後の大動脈弁置換術(AVR)においては, 開胸の際にグラフトや心大血管を損傷したり, 大動脈遮断中にグラフト灌流領域の心筋保護が不十分になる等の問題がある. 著者らはCABG後, 数年を経てAVRを施行した症例を経験したので報告する. 「症例」症例：79歳, 女性 主訴：労作時呼吸苦 既往歴, 家族歴：特記事項なし 現病歴：74歳時に左冠動脈主幹部病変ら＋3枝病変に対し, 当院にて4枝CABGを施行, 左内胸動脈(LITA)を左前下行枝に, 大伏在静脈グラフト(SVG)を右冠動脈, 対角枝, 鈍縁枝にバイパスを行った. その際に大動脈弁狭窄(AS)を指摘されていたが, 大動脈弁引き抜き圧較差が30㎜Hgであったため同時手術は行わなかった. 78歳頃より労作時の呼吸苦が出現するようになり, 79歳時の平成12年11月心臓カテーテル検査を施行した. CABG後のグラフトは全て良好に開存していたが, 大動脈弁圧較差は78mmHgと増大しており, 手術適応と判断され, 平成13年1月に手術目的で入院となった. |
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| Practice | 基礎医学・関連科学 |
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| Keywords | Aortic valve replacement, Coronary artery bypass grafting, Reoparation, Combined oparation |
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| English |
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| Title | Aortic Valve Replacement in a Patient with Patent Grafts after Coronary Artery Bypass Grafting. |
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| Authors | Nobuaki Kaki, Takao Imazeki, Kihito Irie, Hiroshi Kiyama, Noriyuki Murai, Shigeyoshi Gon, Masahito Saitho, Souichi Shioguchi, Takanori Uthida, Tomofumi Thiba, Syuuichi Okada |
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| Authors(kana) | |
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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 | 22 |
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| Number | 4 |
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| Page | 375-379 |
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| Year/Month | 2001/ |
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| Article | Report |
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| Publisher | Japan Society of Circulation Control |
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| Abstract | A 79-year-old woman who had mild aortic stenosis (AS) with pressure gradient 30 mmHg underwent only coronary artery bypass grafting (CABG) 5 years ago. She was readmitted due to heart failure. Cardiac catheterization was performed to evaluate AS and graft patency. The left internal thoracic artery and two saphenus vein grafts were patent, while the aortic valve pressure gradient was increased to 78mmHg. Aortic valve replacement (AVR) was performed by median resternotomy. Generally, it had to be considerated that avoiding graft and heart injury, and myocardial protection of the region especially perfused by grafts are very important in this operation. In this case the right ventricular wall was injured, but still the AVR was successfully perfomed, and the postoperative course was uneventful. Since AVR after CABG has been reported to be with high operative mortality, we recommend simultaneous AVR with CABG to avoid risky secondary operation even in patients with relatively mild AS. |
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| Practice | Basic medicine |
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| Keywords | Aortic valve replacement, Coronary artery bypass grafting, Reoparation, Combined oparation |
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