僧帽弁形成術後12年目の僧帽弁狭窄症に対して再手術を行った1例

Further Surgery for Mitral Stenosis 12-years after Mitral Valve Repair；Report of a Case

はじめに　僧帽弁閉鎖不全症（MR）に対する外科治療の第一選択は僧帽弁形成術であるが，術後再手術を要する原因はリウマチ性を除くとMRの再発がほとんどで，僧帽弁狭窄症（MS）はまれである．われわれは，非リウマチ性によるMRに対し僧帽弁形成術を行った12年後の心不全を伴うMSに対し，僧帽弁置換術を行った症例を経験したので報告する．

A rare case of mitral stenosis after mitral valve repair for non-rheumatic mitral regurgitation is presented. An 81-year-old woman who had undergone mitral valve repair using an annuloplasty ring 12 years earlier, was referred to our hospital because of dyspnea during exertion. As echocardiography revealed severe mitral stenosis, and redo surgery was carried out. During the surgery, fibrous tissue covered the annuloplasty ring and extended onto both leaflets of the mitral valve, which narrowed its orifice, by rendering the leaflets stiff and immobile. It was not possible to remove the fibrous tissue covering the mitral valve without damaging the leaflets. Hence, the annuloplasty ring and both leaflets were excised. The mitral valve was replaced with a 27 mm Magna Mitral Ease, and subsequently, postoperative course was uneventful.