移植後47年で再弁置換を施行した三尖弁位Wada-Cutter弁の1例

Redo Valve Replacement of Wada-Cutter Prosthetic Valve at Tricuspid Valve Position 47 Years After Implantation；Report of a Case

はじめに　Wada-Cutter弁は中心流の確保をめざした革新的な傾斜ディスク弁であったが，その優れた血行動態特性の一方，テフロンディスクが早期に破壊されて脱落し，致命的な塞栓症や弁機能不全が続発したため，使用中止となった．われわれは，47年前に三尖弁位にWada-Cutter弁が移植された症例の人工弁機能不全に対して，再弁置換を施行した．移植状態で現存した最長の症例と思われたが，本例に関しては人工弁の構造的な破壊は認められなかったため報告する．

We experienced an explantation of Wada-Cutter prosthetic tilting disk valve of 47 years after implantation. The patient was 53 years old female who underwent the 1st operation for Ebstein’s anomaly, which included tricuspid valve replacement （TVR）, closure of atrial septal defect （ASD） and posterior annulorrhaphy when she was 6 years old. She was doing well after the 1st operation without symptom, but dyspnea and systemic edema worsened recently though increased admission of diuretics. Echocardiography revealed severe tricuspid valve stenosis, severe tricuspid valve insufficiency, and increased right atrium volume. The tilting disk of the valve was almost fixed. The patient underwent repeat TVR. The explanted Wada-Cutter valve was covered by pannus the whole casing and disk. The structure of the valve was preserved but the occlusion disk was almost fixed by pannus formation, not distorted or dislodged.