三度目の感染性心内膜炎に対しウシ心膜で縫着部を被覆した僧帽弁置換術の1例

Covering Suture Line Using Bovine Pericardium during Mitral Valve Replacement for Third Time Infectious Endocarditis；Report of a Case

はじめに　感染性心内膜炎（IE）の外科的治療後はすみやかに感染制御を得られることが多いが，まれに再感染を起こすことがあり，その際は治療に難渋することが多い．抗生物質治療で感染制御が得られないときには再手術を要するが，活動期IEに対する再手術であり，難易度の高い手術となる．われわれは，難治性アトピー性皮膚炎を背景とした繰り返すIEに対し三度目の手術を要し，ウシ心膜を使用することにより感染制御，再発予防を講じた症例を経験したため報告する．

A 33-year-old man presenting with fever, fatigue, and delirium was diagnosed with infectious endocarditis （IE）. He had already undergone surgery for IE twice；initial valve repair 4 years ago and mitral valve replacement （MVR） 1 year later. He has refractory atopic dermatitis, which was considered to be the cause of his repeated IE. Initially, antibiotics were administered but the infection was not controlled. Therefore, we decided to perform the 3rd surgery. MVR was performed, and using bovine pericardium, we covered valve cuff and suture felts to separete these parts from blood stream. Postoperative echocardiography showed good prosthetic valve motion without transvalvular regurgitation or paravalvular leak. He was discharged on the 39th postoperative day and has been doing well for 2 years since.