Washing & rubbing法により自己組織のみで弁尖を修復して僧帽弁形成を行った感染性心内膜炎の1例

Treatment of Infective Endocarditis with Mitral Valve Plasty Using only Autologous Leaflets by “Washing and Rubbing Method”：Report of a Case

はじめに　僧帽弁閉鎖不全症（MR）に対する標準術式は僧帽弁形成術（MVP）であるが，感染性心内膜炎（IE）が原因となる症例でMVPが完遂可能か否かは，感染の程度に影響される．われわれは，広範な感染巣を認めた僧帽弁位活動期IEに対し，疣贅や破壊が重度な組織のみを切除した後に弁尖を入念に擦過・洗浄するwashing & rubbing法により，自己組織のみで弁尖を修復した症例を報告する．

We performed mitral valve plasty （MVP） with vegetation debridement by rubbing with a small gauze ball and by rinsing with saline （named “washing and rubbing method”） for mitral regurgitation （MR） due to active infective endocarditis （IE）. A 28-year-old male was referred to our hospital with a two-week history of fever. He had renal impairment and anemia, and echocardiography showed severe MR and two vegetations measuring more than 1 cm on the anterior and posterior mitral leaflets （A2-A3 and P2-P3）. Severely damaged leaflets were resected and the vegetations were removed by “washing and rubbing method”. After the method, treatment by 0.625％ glutaraldehyde solution was added to leaflets for its bactericidal and reinforcing effects. MVP using only autologous leaflets was then performed. “Washing and rubbing method” enabled us to avoid using pericardium （autologous/xenogeneic） and/or artificial chordae in infected sites. MVP using “washing and rubbing method” may improve the long-term prognosis of active IE.