三尖弁単独の活動期感染性心内膜炎に対する弁置換術の1例

A Successful Case of Valve Replacement for Isolated Tricuspid Valve Endocarditis

　術前40日間の抗生物質療法に反応せず，多発性の肺塞栓を合併し，敗血症が遷延する19歳，男性の三尖弁単独の感染性心内膜炎に対して，感染活動期に弁置換術を行い良好な結果を得た．本例では三尖弁全尖に疣贅を認め，特に中隔尖の疣贅は直径30mmであり，炎症は弁輪部へ波及していた．弁修復術は不可能と判断し，33mmのCarpentier-Edwards牛心膜弁による弁置換術を行った．右心系の感染性心内膜炎の外科治療とその問題点について文献的考察を加えて報告する．

A case is presented describing succesful valve replace-ment for isolated tricuspid valve endocarditis (TVE). A 19-year-old man was admitted to our department complaining of high fever despite antibiotic chemother-apy. Echocardiogram showed vegetations in all cusps of the tricuspid valve, and moderate tricuspid regurgita-tion. Pulmonary blood scintigram showed multiple thromboembolism. Blood cultures revealed sta-phylococcus aureus. The tricuspid valve was replaced by Carpentier-Edwards xenograft (# 33 mm) during the active phase of TVE.