Starr-Edwardsボール弁に対して術後45年で再弁置換術を施行した1例

Valve Re-replacement after Aortic Valve Replacement with Starr-Edwards Ball Valve Forty-five Years Ago：Report of a Case

はじめに　Starr-Edwards弁（SE弁）は，1960～1970年代に大動脈弁や僧帽弁の弁置換術で主に使用されたボール弁である1）．われわれは45年前にcloth-covered型と思われるSE弁で大動脈弁置換術を施行された患者の再弁置換術を経験したので，文献的考察を加えて報告する．

The patient was a 67-year-old man. At 22 years of age, he underwent aortic valve replacement with Starr-Edwards ball valve. At 67 years of age, he complained of fatigue of the New York Heart Association （NYHA） classⅢcondition. He was diagnosed with mitral regurgitation, tricuspid regurgitation, ascending aortic aneurysm and chronic atrial fibrillation. Transthoracic and transesophageal echocardiograms showed a mobile, elongated echogenic mass attached to the valve cage and floating downstream. We performed Bentall procedure, ascending aortic replacement, mitral valve replacement, tricuspid annuloplasty and left atrial appendage closure. Explanted ball valve showed extensive cloth destruction and partial cloth tear. Mild pannus formation was observed beneath the valve. Despite 45 years after initial operation, significant valve dysfunction was not observed.