僧帽弁置換術後の高度肺高血圧を伴う人工弁機能不全に対する経皮的心肺補助併用下麻酔導入低侵襲心臓手術

Minimally Invasive Cardiac Surgery Following Anesthesia Induction under Percutaneous Cardiopulmonary Support for Prosthetic Valve Dysfunction and Severe Pulmonary Hypertension in a Patient with Previous Mitral Valve Replacement

再胸骨正中切開による僧帽弁手術は，胸骨と心大血管の癒着が著しい症例や冠状動脈バイパス術後例では，心大血管やグラフト損傷の危険が伴う．われわれは，僧帽弁置換術（MVR）後の高度肺高血圧を伴う人工弁機能不全例に対し，経皮的心肺補助（PCPS）併用下に麻酔を導入し，右側方開胸アプローチによる低侵襲心臓手術（MICS）で再MVRを行うことにより，右心不全の著明な改善を得たので報告する．

A 47-year-old woman with a history of mitral valve replacement （MVR） through a median sternotomy was admitted to our hospital due to dyspnea on exertion. Echocardiography showed bioprosthetic valve dysfunction with mitral stenosis. Right heart catheter examination revealed severe pulmonary hypertension and right ventricular dysfunction. We considered that she could not tolerate the hemodynamic changes during induction of general anesthesia without any cardiopulmonary support. Therefore, the percutaneous cardiopulmonary support was started before induction of anesthesia. To avoid the risk of injury to cardiac structures, we performed redo mitral valve replacement via right mini-thoracotomy in the 4th intercostal space. Severe calcification was found in the leaflets of the prosthetic valve. She was discharged home on postoperative day 42.