福島医学雑誌 59 巻 3 号　2009

〔症例報告〕

気管狭窄症状を来たした，右側大動脈弓，左鎖骨下動脈起始
異常を伴うKommerell憩室の1手術例

佐藤　善之¹⁾，丹治　雅博²⁾，横山　　斉¹⁾

¹⁾福島県立医科大学心臓血管外科, ²⁾財団法人太田総合病院太田西の内病院心臓血管外科

（受付2009年6月9日　受理2009年6月23日）

A Case of Kommerell's Diverticulum with Right Aortic Arch and Abberant Left
Subclavian Artery Presenting Tracheal Compression; Report of a Case

YOSHIYUKI SATO¹⁾, MASAHIRO TANJI²⁾ and HITOSHI YOKOYAMA¹⁾

¹⁾Department of Cardiovascular Surgery, Fukushima Medical University, Fukushima, Japan, ²⁾Department of Cardiovascular Surgery, Ohta-Nishinouchi Hospital, Fikushima, Japan

要旨: 右側大動脈弓（Right aortic arch: RAA）に左鎖骨下動脈起始異常（Abberant left subclavian artery: ALSA）を合併したKommerell憩室（Kommerell's diverticulum: KD）は，非常に希な先天性大動脈形成異常疾患である。大動脈の解剖学的特殊性から，定型的胸部大動脈瘤外科手術法での到達経路，補助循環法等では，対応困難な場合も多く，症例毎の術式検討が必要となる特殊な病態である。今回，RAA，ALSA，KD症例に対する手術例を経験したので報告する。症例は，40歳，女性。半年前より，感冒症状に付随する呼吸困難を生じていた。胸部造影CT上，RAA，ALSA，KD，およびALSA起始部を中心とした大動脈瘤（最大径50 mm）を認めた。手術は，右開胸法，部分体外循環下に遠位弓部-下行大動脈人工血管置換術，および，左鎖骨下動脈人工血管再建術を施行した。術後の造影CT上，瘤圧排による気管狭窄は良好に解除され，呼吸器症状も改善し，周術期合併症もなく独歩退院された。

索引用語: Kommerell憩室瘤，右側大動脈弓，左鎖骨下動脈起始異常，気管狭窄

Abstract: A 40 year-old female admitted to our hospital presenting respiratory distress syndrome after upper respiratory infection over several months. Contrast-enhanced computed tomography showed severe tracheal stenosis suggesting of extrinsic compression owing to rapidly-dilated Kommerell's diverticulum (KD) concomitant with aberrant left subculavian artery (ALSA) and right aortic arch (RAA). Because of dilated descending aorta and large saccular aneurysmal formation of KD, elective aneurysmectomy and graft replacement of distal arch to descending aorta were performed via right thoracotomy under normothermic partial extracorporeal circulation to prevent fatal diverticulum rupture. Aneurysmal aorta was replaced using prosthetic tube graft and ALSA was reconstructed with interposition graft using inclusion technique under intraluminal balloon occulusion. Post operative computed tomography showed full recovery of tracheal lumen and her respiratory symptom had markedly relieved. Perioperative complication was not observed. Formerly there were fewer surgical reports of KD with ALSA and RAA showing severe tracheal compression. We experienced a rare case of anatomical repair of widely-involved, non-calcified aortic aneurysm with KD,ALSA and RAA via right thoracotomy and successfully managed surgically.

Key words: Kommerell's diverticulum, right aortic arch, abberant left subclavian artery, tracheal stenosis