逆行性心筋保護法を併用した左上大静脈遺残症合併の再弁膜症手術の1例

Retrograde Cardioplegia in a Case of Persistent Left Superior Vena Cava: a case of repeated heart-valve surgery

　患者は56歳，女性．直視下僧帽弁交連切開術後18年目に大動脈弁置換術，僧帽弁置換術，三尖弁輪縫縮術を施行した．初回手術時に左上大静脈遺残症（PLSVC）の診断を受けていた．今回，手術前のPLSVCの造影検査で細い無名静脈が残存し，閉塞試験で左上肢静脈圧の上昇を認めなかった．術中にPLSVCは結紮し，順行性心筋保護法と拡大した冠静脈洞に巾着縫合をおいた逆行性心筋保護法の併用が有効であった．PLSVCは，再開心術に際して剥離などの処置が必要となり，可能であれば術前より検査し，次回の手術の安全性も考慮し積極的に結紮する方針である．

　We report a case of repeated heart-valve surgery in apatient with persistent left inferior vena cava (PLSVC)using retrograde cardioplegia.

　A 56-year-old Japanese female who was known tohave the PLSVC at the time of open mitral commissurotomy 18 years ago, required aortic and mitral valvereplacement and tricuspid annuloplasty.

　Preoperative occlusion test of the PLSVC showed no elevation in venous pressure of the left arm. The PLSVCwas ligated before the start of cardiopulmonary bypass.We initially used antegrade cardioplegia, and subsequently changed to retrograde cardioplegia (through theSarns Auto Retrograde cannula in the enlarged coronary sinus).

　At the time of repetition of open heart surgery, oreven for the initial operation, we recommend ligation of PLSVC if it is found to be safely occluded preoperatively. We recommend this because PLSVC tends tocomplicate open-heart surgery.