経カテーテル的大動脈弁置換術後の感染性心内膜炎に対する外科的修復術

Surgical Treatment of Acute Infective Endocarditis after Transcatheter Aortic Valve Replacement

本邦でも，高齢で合併症を伴う大動脈弁狭窄症（AS）に対する経カテーテル的大動脈弁置換術（TAVR）が普及してきた．TAVR後の感染性心内膜炎（IE）は比較的まれであるが，発症すると高い死亡率が報告されており，重篤な合併症である．われわれはTAVR後に発症したIEに対し，生体弁による大動脈弁置換術（AVR）を含む外科的心内修復術を行った症例を経験したので報告する．

Infective endocarditis （IE） after transcatheter aortic valve replacement （TAVR） is a rare complication, but has a high mortality. An 86-year-old female with symptomatic severe aortic stenosis underwent TAVR at our hospital and she was discharged without complication after 10 days. She was readmitted with high fever and acute heart failure 1 month later. Blood culture revealed Staphylococcus, and echocardiography showed vegetation on the septal cusp of the tricuspid valve and perforation at the membranous ventricular septum. We decided to perform emergency operation due to active infection and intracardiac complication despite appropriate antibiotic treatment. The infected valve was replaced with a bioprosthetic valve and the right ventricular （RV）-left ventricular （LV） communication was closed with a bovine pericardial patch. The patient received the antibiotics for 6 week and was transferred to the previous facility.