人工腱索長を容易に決められる新しい人工弁輪を用いた僧帽弁形成術

Mitral Valve Repair Using a New Artificial Ring which Enables to Decide the Length of Artificial Chordae

僧帽弁閉鎖不全症（MR）に対する手術として，現在では弁形成術が主流となっている．僧帽弁形成術（MVP）における人工腱索による腱索再建は，従来の逸脱弁尖切除を中心とする形成法と比較しても遜色なく，良好な成績が報告されている．しかし，腱索の長さの決定法は一定しておらず，問題点の一つとしてあげられている．そこでわれわれは，Garciaら2）のfolding leaflet techniqueをもとに作成された新しい人工弁輪［Memo 3D ReChord ring：以下，ReChord ring（日本ライフライン社，東京）］を用いて簡便に人工腱索の長さを決定できる腱索再建を行った症例を経験し，良好な初期成績を得たので，文献的考察を加えて報告する．

Recently, mitral valve repair has been the mainstream of the operation for the treatment of mitral valve regurgitation. In particular, chorda reconstruction with artificial chordae is useful for the anterior leaflet. However, there has been no established method determining the length of chordae. In this report, we performed mitral valve repair using Memo 3D ReChord ring which enables to decide the length of chordae more easily. It is based on the concept of folding leaflet technique by Garcia et al. We used this ring in 7 patients （of which 2 were reoperation） in our institution. There was no postoperative death nor complication. Postoperative transthoracic echocardiography showed class 0～Ⅰ mitral valve regurgitation in each case at discharge. This ring helps to make the repair more reproducible and we consider that it enables to decide the length of chordae more easily even in reoperative cases.