Shingo Taguchi

Mitral Valve Plasty in the Active Phase of Infective Endocarditis with Intracerebral Mycotic Aneurysms and Abscesses in the Brain and Lower Limb

症例は38歳,女性.脳膿瘍および下腿膿瘍を合併した感染性心内膜炎により当院へ入院した.入院後の頭部CT検査で脳膿瘍,感染性脳動脈瘤を認めたが,心エコー検査で僧帽弁に径8mmの可動性疣贅を認めたために,準緊急的に疣贅切除術と僧帽弁形成術を施行した.術前にみられた発熱と下腿痛(筋内膿瘍)はすみやかに消失し,脳動脈瘤,脳膿瘍も退縮した.感染活動期に積極的に僧帽弁形成術を行い,全身症状の著明な改善を認めた貴重な経験であり,若干の文献的考察を加えて報告する.

Midterm results of mitral valve repair with the Carpentier-Edwards rigid ring

OBJECTIVE Prosthetic annuloplasty rings play an important role in mitral valve repair. This clinical study was undertaken to evaluate the midterm results obtained with the Carpentier-Edwards rigid ring. METHODS Between October 1991 and March 2005, 112 patients (mean age 53.0 years) underwent mitral valve repair with a Carpentier-Edwards rigid ring at our institution. Degenerative disease was the most frequent cause and a small number had other conditions such as endocarditis and rheumatic disease. Ten patients were in Carpentiers functional class Type I, 101 patients in Type II and 1 patient in Type III, based on valve pathology. Ischemic mitral regurgitation was excluded. The mean follow-up time was 5.3+/-3.6 years (range: 8 days to 12.3 years). All patients were completely followed by echocardiography. RESULTS The rigid ring ranged from 26 to 36 mm in diameter and the most common size was 30 mm. Although the mitral orifice area was decreased after mitral valve repair in all patients, none of them required reoperation because of mitral stenosis or left ventricular outflow tract obstruction (systolic anterior motion). Reduction of both systolic and diastolic left ventricular volumes was observed postoperatively. Ejection fractions were preserved in all cases. The actuarial survival rate was 92.0+/-3.0% at 10 years and the reoperation-free rate at 10 years was 96.0+/-2.0%. CONCLUSION The rigid ring has produced promising midterm results in terms of reoperation-free and survival rates.

A Case of Mitral Restenosis Complicated with Residual Atrial Septal Perforation after 8 Years on PTMC

症例は63歳,女性.8年前,僧帽弁狭窄症(MS)に対し経皮的僧帽弁交連裂開術(PTMC)を施行されていた.今回,僧帽弁狭窄兼閉鎖不全の進行に加えて心房中隔での左-右短絡が確認され手術となった.術中所見では卵円窩上縁より右下方3cmに12×8mmの心房中隔穿孔(ASP)を認めた.手術は僧帽弁置換術,三尖弁輪縫縮術とASP閉鎖を行った.ASPはPTMCに伴う合併症であるが長期的に開存していることは希である.しかし,長期にわたりASPが遺残した場合は,Lutembacher症候群様の血行動態と2次的な三尖弁閉鎖不全症の進行とも相まって両心不全症状を呈する可能性がある.PTMC後に短絡を認めた場合は心エコー検査で注意深く経過を追う必要があると思われた.