心筋梗塞後に後乳頭筋断裂を発症したエホバの証人信者に対し待機的に僧帽弁形成術を行った1例

Mitral Valve Repair in a Jehovah’s Witnesses Patient with Post Myocardial Infarction Papillary Muscle Rupture；Report of a Case

はじめに　急性心筋梗塞後の乳頭筋断裂による僧帽弁閉鎖不全症は致死的な合併症であり，発症後早急に手術が必要で輸血が避けられないことが多い．われわれはエホバの証人信者に対して，待機的に無輸血で僧帽弁形成術を行い，良好な結果が得られた症例を経験したので報告する．

A 70-years old man was referred to our department for acute heart failure due to post myocardial infarction papillary muscle rupture. We planned emergent surgery, but he refused blood transfusion because of religious reason （Jehovah’s Witness）. Therefore, we chose medical therapy using intra-aortic balloon pumping and catecholamine. He was also treated with subcutaneous erythropoietin and intravenous iron supplement to increase preoperative hemoglobin. One month later, we decided to undergo mitral valve repair because he was stabilized with medical treatment. The patient underwent mitral valve repair with artificial chordae through median sternotomy. The mitral valve A3 prolapse was caused by posterior papillary muscle rupture. No blood transfusion was given and postoperative course was uneventful. We experienced successful mitral repair for post infarction papillary muscle rupture in a Jehova’s Witnessess patient.