大動脈二尖弁を伴う高度大動脈弁輪拡張症に対するリモデリング法による自己弁温存基部置換術

Aortic Valve-preserving Root Remodeling in a Patient with Bicuspid Aortic Valve and Severe Annulo-aortic Ectasia

自己大動脈弁温存基部置換術（VPRR）が1990年代前半に相次いで報告され1，2），近年日本でも積極的に導入する施設が増加してきた．日本では大動脈弁を人工血管の中に再移植するreimplantation法が普及しているが，われわれは大動脈二尖弁を伴う高度の大動脈弁輪拡張症（AAE）に対してValsalva洞壁のみを人工血管で置換するリモデリング法を行い，良好な結果を得たので報告する．

A 48-year-old man underwent aortic root remodeling for a giant aneurysm of sinus of Valsalva, 98 mm in diameter, as well as a bicuspid aortic valve. The aortic valve was defined as type 0 （L-R） according to Sievers classification and the aortic annulus was highly dilated up to 35 mm. Geometric height of the left and right cusps were 22 mm and 32 mm in diameter, respectively. Dacron straight graft of 24 mm was chosen and each tongue was then created in a 180°fashion. After completion of root reconstruction, external circular suture annuloplasty using CV-0 expanded polytetrafluoroethylene （ePTFE） was made to adjust the annulus down to 22 mm in diameter. The free margin of both cusps were centrally plicated to raise the effective height to 9 mm. Postoperative echocardiography at 2 year showed trivial aortic regurgitation but no root re-dilatation. Remodeling with external circular suture annuloplasty is a reproducible and reliable method to stabilize the root, even for the patient with a giant aneurysm of sinus of Valsalva.