Fallot四徴症術後遠隔期に僧帽弁位感染性心内膜炎に対して手術を行った1例

Mitral Valve Plasty Late after Tetrology of Fallot Repair：Report of a Case

はじめに　Fallot四徴症（tetralogy of Fallot：TOF）根治術後の遠隔期に右室流出路再建が必要になることは比較的多い1，2）．しかし，これに加えて僧帽弁病変を合併している症例はまれである．われわれは，TOF根治術後遠隔期に僧帽弁位感染性心内膜炎（infectionals endocarditis：IE）を契機に発覚した僧帽弁閉鎖不全症（mitral valve regurgitation：MR）に対して僧帽弁形成術（mitral valve plasty：MVP）を行い，同時に肺動脈弁置換術を併用した右室流出路再建，遺残心室中隔欠損（ventricular septal de­fect：VSD）閉鎖を行った症例を経験したので報告する．

The case was a 32-year-old man. Blalock-Taussig shunt was performed at five months-old for tetralogy of Fallot, and intracardiac repair was performed at four years-old. He was admitted with a diagnosis of infective endocarditis. Preoperative echocardiography showed vegetations on the mitral valve and severe mitral regurgitation. Severe right heart pressure load findings, pulmonary valve stenosis and regurgitation, and residual ventricular septal defect were also observed. The surgery included mitral valve repair, reconstruction of the right ventricular outflow tract, pulmonary valve replacement, and closure of the ventricular septal defect. The postoperative course was favorable. The cause of mitral regurgitation was an abnormal chordae tendineae attached to the interventricular septum and valve destruction by infective endocarditis.