感染性心内膜炎に伴う僧帽弁前尖穿孔を長軸方向に直接閉鎖した1例

Longitudinal Direct Closure of Mitral Anterior Leaflet Large Perforation for Infective Endocarditis：Report of a Case

はじめに　感染性心内膜炎（infective endocarditis：IE）と診断された症例の約半数は外科的介入が必要となる1）．感染性疾患に対して人工物の使用は極力避けるべきであり，僧帽弁位IEにおける僧帽弁形成術（mitral valve plasty：MVP）の僧帽弁置換術（mitral valve replacement：MVR）に対する優位性が報告されている2）．われわれは，僧帽弁位IEによる比較的大きな前尖穿孔に対して，長軸方向の直接閉鎖（direct closure）および弁輪縫縮術（人工弁輪使用）により僧帽弁逆流を制御することができた症例を経験したので報告する．

A 65-year-old man was presented with infective endocarditis of mitral valve. Echocardiography revealed severe mitral regurgitation and moderate aortic regurgitation. The aortic regurgitant jet directed toward the mitral anterior leaflet, so thickening and perforation of the anterior leaflet of the mitral valve were observed. In addition, Staphylococcus epidermidis was detected in blood culture. After infection control, aortic valve replacement and mitral valve repair was performed. A 17 mm diameter perforation of the anterior mitral leaflet were closed directly and longitudinally with 5-0 prolene polypropylene suture and mitral valve regurgitation was controlled. Primary closure was simple and effective for anterior mitral leaflet perforation.