特発性血小板減少性紫斑病を合併した大動脈弁閉鎖不全症に対する大動脈弁置換術の1治験例

A Case of Aortic Valve Replacement Due to Aortic Insufficiency with Idiopathic Thrombocytopenic Purpura

要旨　患者は76歳，女性．67歳時に特発性血小板減少性紫斑病と診断された．今回，大動脈弁閉鎖不全症に対する手術目的にて当科入院となった．術前の血小板数は4.2×10⁴/mm³であった．術前7日前より5日間にわたり免疫グロブリン大量静注療法(400mg/kg/日)を施行したが，明らかな血小板数の上昇を認めなかったため，術前日に濃厚血小板20単位の輸血を施行し，血小板数は10.3×10⁴/mm³まで上昇した．手術は大動脈弁置換術(Mosaic ultra19mm)を施行した．特発性血小板減少性紫斑病を合併した大動脈弁閉鎖不全症に対し，術前に免疫グロブリン大量療法と周術期に血小板輸血を併用することにより，大動脈弁置換術を施行し得た．

　A 76-year-old woman with a nine-year history of idiopathic thrombocytopenic purpura(ITP) was referred to our department due to aortic insufficiency. As the platelet count before the operation had decreased to 4.2×10⁴/mm³, intravenous infusion therapy with high-dose immunoglobulin was conducted for 5 days starting from 7 days before the operation. However, no definite increase was observed in the platelet count. Accordingly, twenty units of concentrated platelets were transfused the day before the operation. As a result, the platelet count increased to 10.3×10⁴/mm³. Aortic valve replacement(Mosaic ultra 19mm) was performed. Thus an aortic replacement was successfully performed in an aortic insufficiency patient complicated with ITP by intravenous infusion therapy with high-dose immunoglobulin before the operation in combination with platelet transfusion during the perioperative period.