大動脈弁輪部膿瘍で大動脈弁置換，僧帽弁置換，再大動脈弁置換と3回の手術を施行した1例

Aortic Para-annular Abscess Following Infective Endocarditis Requiring Three Times of Operation：Report of a Case

はじめに　大動脈弁輪部膿瘍を伴う感染性心内膜炎（IE）に対し，経時的な病態の変化に応じて3回の開心術を行って完治することができた症例を報告する．

A 45-year-old man was diagnosed with active aortic valve endocarditis accompanied by massive aortic regurgitation, complete atrioventricular block, para-annular abscess and a mobile large vegetation. He underwent emergency resection of the aortic valve, direct closure of the abscess with an autologous pericardium patch and mechanical valve replacement. Acquired communication between the left ventricle and the right atrium was closed simultaneously. Then, adjacent mitral para-annular abscess and another vegetation were revealed by echocardiography, and treated surgically 20 days after the first operation. He underwent mitral valve replacement and closure of the annular abscess. Twenty-one days after the second operation, aortic annular false aneurysm was detected by echocardiography, and closure of the false aneurysm and aortic valve re-replacement were performed successfully.