External suture annuloplasty のみで修復した Type Ic 大動脈弁閉鎖不全症の1例
症例は52歳男性．熱発と浮腫を主訴に受診した．原因精査で大動脈弁の活動期感染性心内膜炎と診断され，血液培養からStreptococcus gallolyticus subsp. pasteurianusが検出された．歯科治療と同時に抗生剤投与を行い感染はコントロールできたが，大動脈弁に可動性のある疣贅の残存が疑われ，大動脈弁輪拡大が主たる原因の重度大動脈弁閉鎖不全症が残存したため手術の方針となった．術中所見で大動脈の弁尖はほぼ正常であり，二度の大動脈遮断を必要としたがexternal suture annuloplastyのみで形成可能であった．術後1年間，大動脈弁輪径も不変で大動脈弁に対する...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 48; no. 4; pp. 239 - 244 |
|---|---|
| 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
15.07.2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.48.239 |
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| Abstract | 症例は52歳男性．熱発と浮腫を主訴に受診した．原因精査で大動脈弁の活動期感染性心内膜炎と診断され，血液培養からStreptococcus gallolyticus subsp. pasteurianusが検出された．歯科治療と同時に抗生剤投与を行い感染はコントロールできたが，大動脈弁に可動性のある疣贅の残存が疑われ，大動脈弁輪拡大が主たる原因の重度大動脈弁閉鎖不全症が残存したため手術の方針となった．術中所見で大動脈の弁尖はほぼ正常であり，二度の大動脈遮断を必要としたがexternal suture annuloplastyのみで形成可能であった．術後1年間，大動脈弁輪径も不変で大動脈弁に対する再手術の必要性も認めていない．有効な症例は限定されるものの，この手技を用いることで手術時間短縮による侵襲の低減および人工弁の使用を回避できる可能性があると考えられる． |
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| AbstractList | 症例は52歳男性．熱発と浮腫を主訴に受診した．原因精査で大動脈弁の活動期感染性心内膜炎と診断され，血液培養からStreptococcus gallolyticus subsp. pasteurianusが検出された．歯科治療と同時に抗生剤投与を行い感染はコントロールできたが，大動脈弁に可動性のある疣贅の残存が疑われ，大動脈弁輪拡大が主たる原因の重度大動脈弁閉鎖不全症が残存したため手術の方針となった．術中所見で大動脈の弁尖はほぼ正常であり，二度の大動脈遮断を必要としたがexternal suture annuloplastyのみで形成可能であった．術後1年間，大動脈弁輪径も不変で大動脈弁に対する再手術の必要性も認めていない．有効な症例は限定されるものの，この手技を用いることで手術時間短縮による侵襲の低減および人工弁の使用を回避できる可能性があると考えられる． |
| Author | 佐々木, 健一 有村, 聡士 松濱, 稔 國原, 孝 |
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| Copyright | 2019 特定非営利活動法人 日本心臓血管外科学会 |
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| References | 5) Boodhwani M, de Kerchove L, Glinuer D et al. Repair-oriented classification of aortic insufficiency : impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg 2009 ; 137 : 286-94. 13) Kunihara T, Arimura S, Sata F et al. Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty. J Thorac Cardiovasc Surg 2018 ; 155 : 885-94. 6) Kunihara T. Annular management during aortic valve repair : a systematic review. Gen Thorac Cardiovasc Surg 2016 ; 64 : 63-71. 1) Meester C, Pasquet A, Gerber BL et al. Valve repair improves the outcome of surgery for chronic severe aortic regurgitation : a propensity score analysis. J Thorac Cardiovasc Surg 2014 ; 148 : 1913-20. 2) Malas T, Saczkowski R, Sohmer B et al. Is aortic valve repair reproducible ?. Analysis of the learning curve for aortic valve repair. Can J Cardiol 2015 ; 31 : 1497. e15-22. 7) Khelil N, Sleilaty G, Palladino M et al. Surgical anatomy of the aortic annulus : landmarks for external annuloplasty in aortic valve repair. Ann Thorac Surg 2015 ; 99 : 1220-6. 10) Miyahara S, Omura A, Sakamoto T et al. Impact of postoperative cusp configuration on midterm durability after aortic root implantation. J Heart Valve Dis 2013 ; 22 : 509-16. 4) Grubitzsch H, Schaefer A, Melzer C et al. Outcome after surgery for prosthetic valve endocarditis and the impact of preoperative treatment. J Thorac Cardiovasc Surg 2014 ; 148 : 2052-9. 12) Capps SB, Elikins RC, Fronk DM. Body surface area as a predictor of aortic and pulmonary valve diameter. J Thorac Cardiovasc Surg 2000 ; 119 : 975-82. 8) Schäfers HJ, Raddatz A, Schmied W et al. Reexaming remodeling. J Thorac Cardiovasc Surg 2015 ; 149 : S30-6. 14) de Kerchove L, Jashari R, Boodhwani M et al. Surgical anatomy of the aortic root : implication for valve-sparing reimplantation and aortic valve annuloplasty. J Thorac Cardiovasc Surg 2015 ; 149 : 425-33. 3) Glacer N, Jacson V, Holzmann MJ et al. Prosthetic valve endocarditis after surgical aortic valve replacement. Circulation 2017 ; 136 : 329-31. 9) Schäfers HJ, Schmied W, Psych D et al. Cusp height in aortic valves. J Thorac Cardiovasc Surg 2013 ; 146 : 269-74. 11) Kunihara T, Aicher D, Rodionycheva S et al. Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg 2012 ; 143 : 1389-95. |
| References_xml | – reference: 11) Kunihara T, Aicher D, Rodionycheva S et al. Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg 2012 ; 143 : 1389-95. – reference: 13) Kunihara T, Arimura S, Sata F et al. Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty. J Thorac Cardiovasc Surg 2018 ; 155 : 885-94. – reference: 1) Meester C, Pasquet A, Gerber BL et al. Valve repair improves the outcome of surgery for chronic severe aortic regurgitation : a propensity score analysis. J Thorac Cardiovasc Surg 2014 ; 148 : 1913-20. – reference: 6) Kunihara T. Annular management during aortic valve repair : a systematic review. Gen Thorac Cardiovasc Surg 2016 ; 64 : 63-71. – reference: 14) de Kerchove L, Jashari R, Boodhwani M et al. Surgical anatomy of the aortic root : implication for valve-sparing reimplantation and aortic valve annuloplasty. J Thorac Cardiovasc Surg 2015 ; 149 : 425-33. – reference: 8) Schäfers HJ, Raddatz A, Schmied W et al. Reexaming remodeling. J Thorac Cardiovasc Surg 2015 ; 149 : S30-6. – reference: 5) Boodhwani M, de Kerchove L, Glinuer D et al. Repair-oriented classification of aortic insufficiency : impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg 2009 ; 137 : 286-94. – reference: 2) Malas T, Saczkowski R, Sohmer B et al. Is aortic valve repair reproducible ?. Analysis of the learning curve for aortic valve repair. Can J Cardiol 2015 ; 31 : 1497. e15-22. – reference: 7) Khelil N, Sleilaty G, Palladino M et al. Surgical anatomy of the aortic annulus : landmarks for external annuloplasty in aortic valve repair. Ann Thorac Surg 2015 ; 99 : 1220-6. – reference: 10) Miyahara S, Omura A, Sakamoto T et al. Impact of postoperative cusp configuration on midterm durability after aortic root implantation. J Heart Valve Dis 2013 ; 22 : 509-16. – reference: 3) Glacer N, Jacson V, Holzmann MJ et al. Prosthetic valve endocarditis after surgical aortic valve replacement. Circulation 2017 ; 136 : 329-31. – reference: 4) Grubitzsch H, Schaefer A, Melzer C et al. Outcome after surgery for prosthetic valve endocarditis and the impact of preoperative treatment. J Thorac Cardiovasc Surg 2014 ; 148 : 2052-9. – reference: 9) Schäfers HJ, Schmied W, Psych D et al. Cusp height in aortic valves. J Thorac Cardiovasc Surg 2013 ; 146 : 269-74. – reference: 12) Capps SB, Elikins RC, Fronk DM. Body surface area as a predictor of aortic and pulmonary valve diameter. J Thorac Cardiovasc Surg 2000 ; 119 : 975-82. |
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| Snippet | 症例は52歳男性．熱発と浮腫を主訴に受診した．原因精査で大動脈弁の活動期感染性心内膜炎と診断され，血液培養からStreptococcus gallolyticus subsp. pasteurianusが検... |
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| SubjectTerms | external suture annuloplasty 大動脈弁形成 大動脈弁輪拡大 大動脈弁閉鎖不全症 感染性心内膜炎 |
| Title | External suture annuloplasty のみで修復した Type Ic 大動脈弁閉鎖不全症の1例 |
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