健常者に発症した三尖弁感染性心内膜炎に対して胸骨正中小切開により三尖弁形成術を施行した1例

A Case of Tricuspid Valve Repair by Quadrangular Resection and Carpentier Ring via Ministernotomy for a Patient with Healed Endocarditis

　基質的な心疾患や重篤な全身疾患，薬物不正使用歴を持たずに発症したきわめて稀な三尖弁感染性心内膜炎の1例を経験した．症例は23歳，女性．不明熱で発症し，血液培養からStaphylococcus aureusを検出，心エコーにて三尖弁位感染性心内膜炎の診断を得た．急性期には抗生剤の投与により感染を抑制できたが，次第に三尖弁逆流が増強，4年後に右室径は46.0mmに拡大し弁形成術を要した．胸骨逆L字小切開法を用いた低侵襲心臓手術により，前尖矩形切除とCarpentier ringを使用した弁輪縫縮を施行した．術後は感染の再燃，心不全の兆候はなく，心エコーで三尖弁逆流は消失しRVDdは23.9mmに縮小した．

　A successful case of repair of endocarditis of the tricuspid valve is reported. A 19-year-old non-addicted woman had recurrent fever after dental treatment, and blood culture revealed Staphylococcus coleus. Echocad-diography showed vegetation on the anterior leaflet of the tricuspid valve, moderate tricuspid regurgitation, and no evidence of congenital anomalies. The diameter of the right ventricle (RVDd) was 32. 0 mm. The infection was resolved with antibiotic therapy, and the patient did not develop heart failure. She was treated in the out-patient department. During the four years of follow-up, she developed severe tricuspid regurgitation, enlargement of the right ventricle to 46.0mm and eventually experienced heart failure. A quadrangular resection of the anterior tricuspid leaflet and an annuloplasty using a Carpentier ring was performed by inverted L ministernotomy. The patient was discharged 10 days after surgery. CTR and RVDd decreased markedly.