大動脈弁輪膿瘍を合併した大動脈弁位感染性心内膜炎に対してステントレス生体弁を用い大動脈基部置換術を施行した1例

Replacement of the Aortic Root with Stentless Bioprosthesis for Prosthetic Valve Endocarditis with Aortic Root Abscess；Report of a Case

はじめに　人工弁感染性心内膜炎は非常に重篤な病態であるため，手術死亡率・合併症率ともに高い．われわれは，大動脈弁輪膿瘍を合併した人工弁感染性心内膜炎に対してFreestyle弁を用い良好な成績を得たので，文献的考察を交えて報告する．

An 81-year-old man who had undergone aortic valve replacement was transferred to our hospital due to suspected prosthetic valve endocarditis （PVE） from the regional hospital. Transesophageal echocardiography findings showed severe aortic regurgitation with mobile vegetation on the right coronary cusp and annular abscess corresponding to left-none coronary cusps. Urgent operation was performed under the diagnosis of PVE with aortic root abscess. Intraoperative findings demonstrated tiny vegetation on one of the bio-prosthetic leaflets and abscess formation beneath the left sinus of valsalva （LSOV）. Complete debridement of the infected tissue followed by patch closure of the cavity below the LSOV and reconstruction of the aortic root with Freestyle stentless aortic bioprosthesis was performed. His postoperative course was uneventful. Aortic root replacement using a stentless bioprosthesis seems to represent one of the useful options for PVE with aortic root abscess.