金属アレルギーを有する連合弁膜症患者に対する2弁置換・1弁形成術

Mitral and Aortic Valve Replacement and Tricuspid Valve Repair in a Patient with Metal Allergy

心臓血管外科領域では人工弁や人工弁輪，リズムデバイスや血管内ステントなどの人工臓器と，胸骨ワイヤーや血管結紮クリップ，一時的ペーシングワイヤーなどの手術材料の構成成分として，さまざまな金属が使用されている．金属アレルギーはⅣ型アレルギーに分類され，原因物質となる金属を体内に留置した場合にはさまざまなアレルギー反応を示す．われわれは，金属アレルギーを有した連合弁膜症患者に対する手術経験を報告する．

We report a 63-year-old woman came to our hospital with exertional dyspnea, palpitations, and abdominal distention. Echocardiography showed mitral, aortic, and tricuspid valve insufficiency, for which surgery was indicated. Twenty-six years ago, during dental therapy, she was diagnosed with metal allergy. A patch test demonstrated allergic reactions to manganese, chromium, and zinc. The patient underwent mitral and aortic valve replacement with the On-X prosthetic heart valve, which is primarily made of titanium and devoid of the allergens. She also underwent tricuspid valve repair with a Contour 3D annuloplasty ring, which is made of titanium alloy. She manifested no allergic symptoms three years after surgery. This case elucidates the importance of history taking regarding metal allergy and identification of allergens by patch testing in patients undergoing cardiac surgery involving metal device implantation.