低心機能成人修正大血管転位症に対して弁尖温存三尖弁置換術を施行した1例

Tricuspid Valve Replacement Preserving the Leaflets in a Congenitally Corrected Transposition of the Great Arteries；Report of a Case

はじめに　成人期における修正大血管転位症（ccTGA）は，体心室の術前心機能が駆出率（EF）＜40％である場合，体循環房室弁逆流への外科的介入は生命予後が有意にわるいとされており2），低心機能になる前の手術介入が推奨されている．一方で，診断時にすでに重度の低心機能となっており，耐術可能か判断に迷う症例がある．カテコラミン依存であった重度低心機能のccTGAに，体循環房室弁置換術を行った1例を報告する．

In patients with a congenitally corrected transposition of the great arteries （ccTGA）, the regurgitation of the systemic atrioventricular valve （SAVV） increases and anatomical right ventricular （ARV） dysfunction often progressively develops. A low systemic ventricular ejection fraction （SVEF） is a risk factor for mortality. However, in patients with a low ejection fraction of ARV, it is unclear how to best perform valve replacement for patients with regurgitation of SAVV. A 70-year-old female with respirator discomfort was admitted to our hospital and diagnosed to have situs solitus ccTGA, severe SAVV regurgitation, and ARV dysfunction. Her ARV ejection fraction was 25％ and she was therefore dependent on inotropic agents. We successfully performed a tricuspid valve replacement while preserving the leaflets, the chorda tendineae’s, and papillary muscles, and placing the lead for cardiac resynchronization therapy on the ARV. Her postoperative course was uneventful. Thereafter, she was discharged 6 weeks after surgery.