パッチ離開によりmitral-aortic intervalvular fibrosaに仮性動脈瘤を形成した大動脈弁位感染性心内膜炎

Pseudoaneurysm of Mitral-aortic Intervalvular Fibrosa Due to the Detachment of Intracardiac Patch after Aortic Valve Replacement in a Patient with Infective Endocarditis

感染性心内膜炎（IE）による弁輪部膿瘍は発生部位，大きさ，拡大方向によってさまざまな病態を示す．弁輪部膿瘍に対する手術は膿瘍腔の郭清を徹底的に行い，必要なときは弁輪部の形成後に弁置換を行うことが重要となる．大動脈弁はIEの好発部位であるが，mitral-aortic intervalvular fibrosa （MAIVF）の仮性動脈瘤形成は比較的まれである．大動脈弁位の活動期IEに対し，MAIVF膿瘍へのパッチ形成および弁置換術を施行した後，パッチ離開によりMAIVFに仮性動脈瘤拡大をきたした1例を経験したので報告する．

A 67-year-old woman was referred to our hospital with a diagnosis of aortic stenosis. As she had concurrent breast cancer, resection of the left breast was 1st performed. She then suffered from infection of the breast wound followed by infective endocarditis. She underwent aortic valve replacement （AVR） with a patch plasty of the perivalvular abscess in the mitral-aortic intervalvular fibrosa （MAIVF）. Four months after the AVR, severe aortic regurgitation occurred due to a pseudoaneurysm in the MAIVF and re-AVR was performed. The surgery revealed detachment of the intra-cardiac patch caused perivalvular leakage. Subsequently, the patient completely recovered following the redo surgery.