前乳頭筋部分断裂による急性僧帽弁閉鎖不全症に対して待機的に僧帽弁形成術を施行した1例

Elective Mitral Valve Repair for Acute Mitral Regurgitation Due to Anterior Papillary Muscle Rupture：Report of a Case

はじめに　乳頭筋断裂は通常，急激に循環動態が破綻することから緊急手術を要する症例が多く，いまだ外科的治療の成績も良好ではない．術式に関しては，緊急手術になることが多いため弁置換術を施行する症例が多く，弁形成術を選択できる症例は少ない．われわれは，前乳頭筋部分断裂に対して待機的に僧帽弁形成術を施行し，良好な成績を得たので報告する．

An 83-year-old woman with congestive heart failure due to severe mitral regurgitation was referred to our department. Because acute coronary syndrome was suspected, the patient underwent emergent coronary artery angiography, which showed 75％ stenosis of segment 2 and 90％ stenosis of segment 11. Subsequently, segment 11 was treated by percutaneous coronary intervention. Additionally, transesophageal echocardiography findings showed a prolapse of P2 due to papillary muscle rupture. After management of heart failure, a scheduled operation was performed under the diagnosis of acute mitral regurgitation due to papillary muscle rupture. Intraoperative findings demonstrated a rupture of the anterior papillary muscle, prolapse of P2, and no evidence of infection. The patient underwent mitral valve repair with artificial chordae through median sternotomy. Her postoperative course was uneventful.