大動脈弁置換術後2年4カ月後にバルサルバ洞の著明な拡大を認め，ベントール手技を施行した1例

A Case of Bentall Procedure for Severely Dilated Aortic Root 28 Months after Aortic Valve Replacement

要旨　患者は71歳，女性．バルサルバ洞の拡大を合併した大動脈弁閉鎖不全症(AR)に対し大動脈弁置換術(AVR)を施行した2年4カ月後に径67mmのバルサルバ洞の著明な拡大を認めた．待機的にベントール手技による再手術を施行した．上行大動脈の拡大を合併した大動脈弁膜症に対する手術術式には未だ議論の余地があるが，バルサルバ洞が径54mmの拡大を示す本症例においては，ベントール手技を検討してもよかったのではないかと考える．AVR後は定期的に心臓超音波(UCG)検査を行い，バルサルバ洞の拡大の進行が認められた時点で早めに待機的な再手術を検討すべきであったと思われる．

　A 71-year-old female who underwent AVR for AR associated with mildly dilated ascending aorta and moderately dilated aortic root 28 months before was admitted to our hospital because of severely dilated aortic root. Reoperative Bentall procedure was electively performed and her postoperative course was uneventful. The surgical management of patients with aortic valve disease associated with ascending aortic dilatation is a controversial issue. We think that the Bentall procedure might have been considered for this patient associated with dilated aortic root(54mm). Following AVR, we should have regularly controlled the patient by UCG and electively performed the reoperative Bentall procedure as soon as progression of enlargement of the aortic root had been ditected.