右肺全切除37年後に右開胸による僧帽弁形成術を施行した1例

Mitral Valve Repair via Right Thoracotomy Thirty-seven Years after Right Pneumonectomy：Report of a Case

はじめに　肺切除後は呼吸機能が低下し，開心術を行った場合は人工心肺の影響による肺へのダメージが加わり，人工心肺や人工呼吸器からの離脱が困難になる可能性がある．また肺切除を施行した側に縦隔が偏位するため，心臓および大動脈が通常とは異なる位置となり，さらに肺切除後の死腔に代替内容物が充満することで，視野確保に工夫を要することが多い．われわれは，右肺全摘出後の僧帽弁閉鎖不全症（MR）に対し，右開胸による僧帽弁形成術を行い，良好な結果を得たので報告する．

A 57-year-old man was referred to our hospital due to dyspnea on exertion with severe mitral regurgitation. Because he had underdone right pneumonectomy 37 years earlier due to congenital defect of the right pulmonary artery, his mediastinum was severely shifted to the right, and his pulmonary function was poor. Mitral valve repair was successfully performed with right thoracotomy approach, which made excellent exposure of the mitral valve. The patient was extubated three hours after the surgery. He was discharged on the 30th postoperative day without postoperative respiratory complications. With an appropriate plan of the surgery and postoperative optimal management, cardiac surgery can be performed on patients with a single lung.