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 大動脈基部とは心臓から大動脈が出る部分でバルサルバ洞、冠動脈入口部、そして大動脈弁が三次元的に構成される重要な部分です。マルファン症候群などで見られるこの部分の異常は、大動脈弁閉鎖不全から心拡大や心不全を発症させ、また拡大するこの部は破裂や解離発症の高い危険があります。従来からあるこの部を人工弁と人工血管に取り替える手術(Bentall手術)とともに、特に若年で抗凝固薬剤を忌避できる「自己弁温存基部置換術」(VSARR, David手術)が近年行われるようになりました。弁尖の形態を長期に最良の状態に保つため様々なテクニックが駆使されますが私たちは、ひとり一人確実な手術手技で丁寧に治療いたします。出血や長時間の人工心肺使用がほとんどなく長期成績の良い手術を行っています。

Valve-sparing aortic root replacement with complex cusp repairs (2014 Asai)

40 year-old man was presented with Marfan syndrome, enlargement of the aortic root, and mild AR. He underwent Valve-sparing aortic root replacement, VSARR, or root re-implantation technique, David procedure. Leaflet abnormalities such as large fenestrations in LCC, NCC redundancy, and tricuspid-like bicuspid valve were noted during the operation, not known preoperatively. Although leaflet tissue was frail and thin, complex cusp repairs, such as fenestration closure, central plication, and free margin re-suspension were performed. Annulus was sized 25mm, and 30mm Gelweave Valsalva, DePaulis graft, was chosen for this operation. Post-CPB AR was none-trivial, and no transfusion was required. Careful observational follow-up is mandatory for the patient, but I am cautiously optimistic that he will do well.