Fallot四徴症術後1弁付きパッチ変性に感染性心内膜炎を合併した1例

Degenerated Monocusp Valve Complicated with Infective Endocarditis after Total Correction of Tetralogy of Fallot；Report of a Case

はじめに　Fallot四徴症（TOF）術後遠隔期に報告されている合併症1）の中で，右室流出路再建に用いられる1弁付きパッチの変性もその一つである．われわれは，原発不明な大動脈弁位感染性心内膜炎に，右室流出路に用いたPolystan社製1弁付きパッチの変性，瘤化，感染を併発し，再手術を要した症例を経験したので，文献的考察を加えて報告する．

There have been few reports about degenerated monocusp-valve patches, which were used for right ventricular outflow tract （RVOT） reconstruction with complications of infective endocarditis after total correction of tetralogy of Fallot （TOF）．

A 44-year-old male patient, who had a total correction of TOF using Monocusp Valved Outflow Patch （MVOP） 34 years previous, was admitted for heart failure with aortic regurgitation. An echocardiographic study showed an infective endocarditis with vegetations, attached to the aortic valve and the monocusp-valve outflow patch. The aortic valve was replaced with a mechanical prosthesis and the pulmonary valve was replaced with a biological prosthesis. RVOT was reconstructed using a bovine pericardial patch. The explanted monocusp-valve was deteriorated and heavily calcified. The postoperative course was uneventful. The patient was discharged and returned to his preoperative lifestyle 36 days after the redo surgery.