雑誌文献を検索します。書籍を検索する際には「書籍検索」を選択してください。

Kokyu to Junkan Volume 43, Issue 9 （September 1995）

呼吸と循環 43巻9号（1995年9月発行）

Japanese English

症例

4弁（大動脈弁，僧帽弁，三尖弁，肺動脈弁）に疣贅を認めた活動性感染性心内膜炎の1手術例 A Case of Rheumatic Valvular Disease Associated with Acute Infective Endocarditis Concomitant with Vegetation on Quadruple Valves (aortic valves, mitral valve, tricuspid valve, pulmonary valve) 佐藤義浩 ¹ , 鎌田潤也 ² , 那須雅孝 ¹ , 蒔田真司 ¹ , 八木葉子 ² , 中居賢司 ¹ , 川副浩平 ² , 平盛勝彦 ¹ Yoshihiro Sato ¹ , Junya Kamata ² , Masataka Nasu ¹ , Shinji Makita ¹ , Yoko Yagi ² , Kenji Nakai ¹ , Kohei Kawazoe ² , Katsuhiko Hiramori ¹ ¹岩手医科大学第二内科 ²岩手医科大学第三外科 ¹Second Department of Internal Medicine, Iwate Medical University ²Third Department of Surgery, Iwate Medical University キーワード：感染性心内膜炎 , 疣贅 , 弁置換術 , infective endocarditis , vegetation , valve replacement Keyword: 感染性心内膜炎 , 疣贅 , 弁置換術 , infective endocarditis , vegetation , valve replacement pp.929-933

発行日 1995年9月15日 Published Date 1995/9/15

DOI https://doi.org/10.11477/mf.1404901122

PDF(9668KB)

有料閲覧

Abstract 文献概要
1ページ目 Look Inside

　症例は64歳，女性．63歳時に僧帽弁狭窄兼閉鎖不全症（MSR）および三尖弁閉鎖不全症（TR）と診断された．発熱と呼吸困難を主訴に本学第二内科に入院した．入院時の血液培養で菌は検出されなかったが，心エコー図検査などで4弁（僧帽弁・大動脈弁・三尖弁・肺動脈弁）全てが感染性心内膜炎に侵されていると診断した．感染に対しペニシリンG2000万単位／日およびゲンタマイシン160mg／日の投与を，心不全に対してはフロセミドの投与を行った．入院後11日目に心不全症状は改善したが，9日目には再び炎症が再燃し，僧帽弁前尖に新たな疣贅が認められた．そのため，本学第三外科で緊急に手術（3弁置換術と肺動脈弁の疣贅切除）を行い，良好な結果が得られた．本症例は，リウマチ性弁膜症を基礎疾患とし，手術所見で4弁全てに疣贅を認めた活動性感染性心内膜炎で，われわれの調べた限りでは，本邦での報告は1例のみであり，極めて稀な症例と考えられた．

A 64-year-old female patient was diagnosed as hav-ing mitral stenosis and regurgitation (MSR) and tricuspid regurgitation (TR) at age 63. There was no history of rheumatic fever. She was hospitalized in March, 1993 because of dyspnea and continuous fever in a condition of class III by the NYHA classification, with an increase in CRP, but we could not identify an obvi-ous bacterium in her blood culture. Echocardiography revealed the presence of MSR, AR, TR, PR and vegeta-tion on the mitral valves. She was considered to have active infective endocarditis (AIE). Penicillin G at a daily dose of 80 mg was intravenously administered to treat the infection. Furosemide was used for congestive heart failure. Since then, although her cardiac function and the signs of the infection appeared to improve during 11 days in the hospital, the signs of the infection reappeared within 19 days and echocardiography revealed new vegetation on the mitral valve. There-fore, triple valve replacement for the mitral, aortic and tricuspid valves and excision of the vegetation on thepulmonary valve were performed and the operation was successful. The operation revealed vegetation on the excised quadruple valves (mitral, aortic, tricuspid, pul-monary valves).

This case is rheumatic valvular disease associated with infective endocarditis which revealed the vegeta-tion on mitral, aortic, tricuspid, pulmonary valves. It is quite a rare case.