New ACC/AHA Aortic Disease Management Guidelines: What do they mean for you?
46:22-49:18
For the class, I'm going to go through this fairly quickly. These are the class one recommendations for type A aortic dissections and I've included them in this presentation. These are very similar to the 2010 recommendations with some expansion.
こちらはA型大動脈解離についてのクラス1の推奨事項です。2010版からの変更点はほとんどありませんが、追加された箇所があります。
And, and it's, the first couple are very common sense and patients who are presenting and they have a suspect or confirmed aortic, acute type A dissection that is recommended that immediate surgical intervention be performed because of the high risk of life-threatening complications.
最初の2つの項目は、ごく当たり前の内容です。1つ目は、急性大動脈解離A型が疑われる、あるいは確定した患者さんでは、命に関わる合併症が起こるリスクが高いため、直ちに外科手術を受ける、というものです。
In patients presenting with evidence of renal, mesenteric or lower extremity malperfusion it is also recommended as class 1 level to proceed with operative repair of the ascending aorta, is still with the type A ??.
2つ目は、腎動脈、腸間膜動脈、下肢の潅流障害の兆候が見られる患者さんでは、外科手術による上行大動脈の修復が推奨されます。やはりこれもA型解離の場合で、推奨クラスは1です。
And then finally in patients with an acute type A dissection and that involves, partially involves the aortic root but the aortic valve leaflets are not diseased, then we recommend to leave the valve re-suspend the the commissures of the aortic valve and this is preferable over valve replacement. Each of these decisions, of course, would be can be altered based on the surgeon's experience or what they've, they see in the operating room but these are our class 1 recommendations, next slide.
推奨クラス1の最後の推奨事項ですが、急性A型解離で、基部にも部分的な影響があるものの、大動脈弁弁尖に病変がない場合は、大動脈弁の交連部（弁の合わせ目）を合わせることが推奨されます。これは弁置換よりも好ましい処置です。もちろん、これらの判断は執刀医の経験や状況に応じて変わることがありますが、推奨クラスは1となっています。
The class 2A recommendation is in those patients presenting with an acute type A or dissection with significant, clinically significant mesenteric malperfusion, their celiac artery, their SMA, these are branches that are feeding the, the guts, if you will, the liver and the belly, the, the colon, the small bowel, then the choice is either immediate operative repair of the ascending aorta or immediate revascularization getting blood to, to your bowels via endovascular or open surgical approach and this will be based on the expertise of the of the surgeon, expertise at the center and as well as the patient, normally endovascular approaches are, are not necessarily performed on patients with connective tissue disorders, however, in life's, life-threatening situations it is reasonable to, to use this as one of your approaches, next slide.
こちらは推奨クラス2Aの推奨事項です。急性A型解離で、腸間膜や腹腔動脈、上腸間膜動脈に臨床上の重篤な潅流障害が見られる場合、選択肢としては、直ちに上行大動脈の修復手術を行うか、血行再建（血管内あるいは外科的アプローチ）を行うかです。どちらになるかは、執刀医および病院の専門性、患者さんによって決まります。通常であれば、血管内アプローチは結合組織疾患の患者さんに行われるとは限りませんが、命が関わる状況においては妥当と考えられます。
And this is a table out of, the out of the, the document, which sort of shows a decision making for those patients with either a type A or a type B aortic dissection including those with malperfusion or ischemia and I won't go through this very detailed chart here, next slide.
こちらの図はガイドラインから抜粋したものです。中身には触れませんが、潅流障害あるいは虚血の有無を含め、A型、B型解離の患者さんを診断する際の指針となっています。
The Marfan Foundation did not participate in the translation of these materials and does not in any way endorse them. If you are interested in this topic, please refer to our website, Marfan.org, for materials approved by our Professional Advisory Board.
The Marfan Foundation は、当翻訳には関与しておらず、翻訳内容に関してはいかなる承認も行っておりません。このトピックに興味をお持ちの方は、Marfan.org にアクセスし、当協会の専門家から成る諮問委員会が承認した内容をご参照ください。
