大動脈弁・僧帽弁置換術後の僧帽弁位人工弁機能不全に対してManouguian法による2弁置換を施行した1例
症例は83歳女性（BSA 1.36 m2）．8年前に重症大動脈弁狭窄症，重症僧帽弁閉鎖不全症，中等症三尖弁閉鎖不全症，心房細動に対して大動脈弁置換術（Magna ease 19 mm），僧帽弁置換術（Epic mitral 25 mm），三尖弁輪形成術（De Vega technique），肺静脈隔離術を他院で施行．来院6カ月前よりの労作時息切れ，呼吸苦等の心不全症状を来し当院紹介．精査にて弁尖の穿孔による僧帽弁閉鎖不全症および人工弁機能不全による僧帽弁狭窄症（平均圧較差7.8 mmHg）による肺高血圧症（安静時平均肺動脈圧 49 mmHg）の診断で，Manouguian法による弁輪拡大と大動...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 52; no. 6; pp. 401 - 405 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本心臓血管外科学会
15.11.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.52.401 |
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| Abstract | 症例は83歳女性（BSA 1.36 m2）．8年前に重症大動脈弁狭窄症，重症僧帽弁閉鎖不全症，中等症三尖弁閉鎖不全症，心房細動に対して大動脈弁置換術（Magna ease 19 mm），僧帽弁置換術（Epic mitral 25 mm），三尖弁輪形成術（De Vega technique），肺静脈隔離術を他院で施行．来院6カ月前よりの労作時息切れ，呼吸苦等の心不全症状を来し当院紹介．精査にて弁尖の穿孔による僧帽弁閉鎖不全症および人工弁機能不全による僧帽弁狭窄症（平均圧較差7.8 mmHg）による肺高血圧症（安静時平均肺動脈圧 49 mmHg）の診断で，Manouguian法による弁輪拡大と大動脈弁再置換術（Inspiris 23 mm）および僧帽弁再置換術（Epic mitral 29 mm）を施行し肺高血圧症の改善を得た． |
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| AbstractList | 症例は83歳女性（BSA 1.36 m2）．8年前に重症大動脈弁狭窄症，重症僧帽弁閉鎖不全症，中等症三尖弁閉鎖不全症，心房細動に対して大動脈弁置換術（Magna ease 19 mm），僧帽弁置換術（Epic mitral 25 mm），三尖弁輪形成術（De Vega technique），肺静脈隔離術を他院で施行．来院6カ月前よりの労作時息切れ，呼吸苦等の心不全症状を来し当院紹介．精査にて弁尖の穿孔による僧帽弁閉鎖不全症および人工弁機能不全による僧帽弁狭窄症（平均圧較差7.8 mmHg）による肺高血圧症（安静時平均肺動脈圧 49 mmHg）の診断で，Manouguian法による弁輪拡大と大動脈弁再置換術（Inspiris 23 mm）および僧帽弁再置換術（Epic mitral 29 mm）を施行し肺高血圧症の改善を得た． |
| Author | 三隅, 寛恭 阿部, 恒平 吉野, 邦彦 玉木, 理仁 山崎, 学 中村, 雄一 |
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| References | 12) Bouchard D, Vanden Eynden F, Demers P et al. Patient-prosthesis mismatch in the mitral position affects midterm survival and functional status. Can J Cardiol 2010; 26: 532-6. 18) Marey G, Said SM. Combined Manouguian-guiraudon approach for double valve replacement: the commando revisited. Ann Thorac Surg 2021; 111: 139-41. 16) Motomura N, Miyata H, Tsukihara H et al. Risk model of thoracic aortic surgery in 4707 cases from a nationwide single-race population through a web-based data entry system: the first report of 30-day and 30-day operative outcome risk models for thoracic aortic surgery. Circulation 2008; 118: 153-9. 2) Magne J, Mathieu P, Dumesnil JG et al. Impact of prosthesis-patient mismatch on survival after mitral valve replacement. Circulation 2007; 115: 1417-25. 10) Pisano C, Balistreri CR, Triolo OF et al. Impact of prosthesis-patient mismatch after mitral valve replacement. J Heart Valve Dis 2016; 25: 39-45. 14) Scotten LN, Walker DK, Dutton JW. Modified gorlin equation for the diagnosis of mixed aortic valve pathology. J Heart Valve Dis 2002; 11: 360-8. 5) Hwang HY, Kim YH, Kim K et al. Patient-prosthesis mismatch after mitral valve replacement: a propensity score analysis. Ann Thorac Surg 2016; 101: 1796-802. 17) David TE, Kuo J, Armstrong S. Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body. J Thorac Cardiovasc Surg 1997; 114: 766-72. 7) Lee SH, Chang BC, Youn Y et al. Impact of prosthesis-patient mismatch after mitral valve replacement in rheumatic population: does mitral position prosthesis-patient mismatch really exist ?. J Cardiothorac Surg 2017; 12: 1-9. 4) Lam B, Chan V, Hendry P et al. The impact of patient-prosthesis mismatch on late outcomes after mitral valve replacement. J Thorac Cardiovasc Surg 2007; 133: 1464-73. 8) Tsubota H, Sakaguchi G, Arakaki R et al. Impact of prosthesis-patient mismatch after mitral valve replacement: a propensity score analysis. Semin Thorac Cardiovasc Surg 2021; 33: 347-53. 6) Shi WY, Yap C, Hayward PA et al. Impact of prosthesis-patient mismatch after mitral valve replacement: a multicentre analysis of early outcomes and mid-term survival. Heart 2011; 97: 1074-81. 13) Ren CL, Gao CQ, Jiang SL et al. Prosthesis-patient mismatch in the mitral valve position: the initial result of a single-institutional observational study in China. Zhonghua Wai Ke Za Zhi 2011; 49: 311-4. 3) Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. J Am Coll Cardiol 2000; 36: 1131-41. 9) Tomšič A, Arabkhani B, Schoones JW et al. Prosthesis-patient mismatch after mitral valve replacement: a pooled meta-analysis of Kaplan-Meier-derived individual patient data. J Card Surg 2020; 35: 3477-85. 11) Matsuura K, Mogi K, Aoki C et al. Prosthesis-patient mismatch after mitral valve replacement stratified by referred and measured effective valve area. Ann Thorac Cardiovasc Surg 2011; 17: 153-9. 15) Sato S, Fujita T, Shimahara Y et al. Impact of prosthesis-patient mismatch on late recurrence of atrial fibrillation after cryomaze procedure with mitral valve replacement. Circ J 2014; 78: 1908-14. 1) Manouguian S, Abu-Aishah N, Neitzel J. Patch enlargement of the aortic and mitral valve rings with aortic and mitral double valve replacement. Experimental study. J Thorac Cardiovasc Surg 1979; 78: 394-401. |
| References_xml | – reference: 10) Pisano C, Balistreri CR, Triolo OF et al. Impact of prosthesis-patient mismatch after mitral valve replacement. J Heart Valve Dis 2016; 25: 39-45. – reference: 11) Matsuura K, Mogi K, Aoki C et al. Prosthesis-patient mismatch after mitral valve replacement stratified by referred and measured effective valve area. Ann Thorac Cardiovasc Surg 2011; 17: 153-9. – reference: 4) Lam B, Chan V, Hendry P et al. The impact of patient-prosthesis mismatch on late outcomes after mitral valve replacement. J Thorac Cardiovasc Surg 2007; 133: 1464-73. – reference: 13) Ren CL, Gao CQ, Jiang SL et al. Prosthesis-patient mismatch in the mitral valve position: the initial result of a single-institutional observational study in China. Zhonghua Wai Ke Za Zhi 2011; 49: 311-4. – reference: 17) David TE, Kuo J, Armstrong S. Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body. J Thorac Cardiovasc Surg 1997; 114: 766-72. – reference: 3) Pibarot P, Dumesnil JG. Hemodynamic and clinical impact of prosthesis-patient mismatch in the aortic valve position and its prevention. J Am Coll Cardiol 2000; 36: 1131-41. – reference: 7) Lee SH, Chang BC, Youn Y et al. Impact of prosthesis-patient mismatch after mitral valve replacement in rheumatic population: does mitral position prosthesis-patient mismatch really exist ?. J Cardiothorac Surg 2017; 12: 1-9. – reference: 18) Marey G, Said SM. Combined Manouguian-guiraudon approach for double valve replacement: the commando revisited. Ann Thorac Surg 2021; 111: 139-41. – reference: 2) Magne J, Mathieu P, Dumesnil JG et al. Impact of prosthesis-patient mismatch on survival after mitral valve replacement. Circulation 2007; 115: 1417-25. – reference: 5) Hwang HY, Kim YH, Kim K et al. Patient-prosthesis mismatch after mitral valve replacement: a propensity score analysis. Ann Thorac Surg 2016; 101: 1796-802. – reference: 6) Shi WY, Yap C, Hayward PA et al. Impact of prosthesis-patient mismatch after mitral valve replacement: a multicentre analysis of early outcomes and mid-term survival. Heart 2011; 97: 1074-81. – reference: 12) Bouchard D, Vanden Eynden F, Demers P et al. Patient-prosthesis mismatch in the mitral position affects midterm survival and functional status. Can J Cardiol 2010; 26: 532-6. – reference: 16) Motomura N, Miyata H, Tsukihara H et al. Risk model of thoracic aortic surgery in 4707 cases from a nationwide single-race population through a web-based data entry system: the first report of 30-day and 30-day operative outcome risk models for thoracic aortic surgery. Circulation 2008; 118: 153-9. – reference: 9) Tomšič A, Arabkhani B, Schoones JW et al. Prosthesis-patient mismatch after mitral valve replacement: a pooled meta-analysis of Kaplan-Meier-derived individual patient data. J Card Surg 2020; 35: 3477-85. – reference: 15) Sato S, Fujita T, Shimahara Y et al. Impact of prosthesis-patient mismatch on late recurrence of atrial fibrillation after cryomaze procedure with mitral valve replacement. Circ J 2014; 78: 1908-14. – reference: 14) Scotten LN, Walker DK, Dutton JW. Modified gorlin equation for the diagnosis of mixed aortic valve pathology. J Heart Valve Dis 2002; 11: 360-8. – reference: 1) Manouguian S, Abu-Aishah N, Neitzel J. Patch enlargement of the aortic and mitral valve rings with aortic and mitral double valve replacement. Experimental study. J Thorac Cardiovasc Surg 1979; 78: 394-401. – reference: 8) Tsubota H, Sakaguchi G, Arakaki R et al. Impact of prosthesis-patient mismatch after mitral valve replacement: a propensity score analysis. Semin Thorac Cardiovasc Surg 2021; 33: 347-53. |
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| Title | 大動脈弁・僧帽弁置換術後の僧帽弁位人工弁機能不全に対してManouguian法による2弁置換を施行した1例 |
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