三尖弁感染性心内膜炎に対する右小開胸心拍動下三尖弁形成術の1例

On-pump Beating Minimally Invasive Cardiac Surgery Valve Plasty for Infective Endocarditis Located in the Tricuspid Valve：Report of a Case

はじめに　感染性心内膜炎（IE）の外科治療においては，感染巣を完全に除去でき自己弁を温存することが可能な症例は，積極的に弁形成術を行うことが望ましい．近年では側方小開胸アプローチによる低侵襲心臓手術が行われる症例が増加しているが，IEにおいても感染巣が限局していれば可能である．

The patient is a 50-year-old man. He was healthy by nature, had fever in the 38 ℃ range for about a week, blood culture identified methicillin-sensitive Staphylococcus aureus （MSSA）, and ultrasoundcardiography （UCG） showed a 10 mm vegetation adherent to the tricuspid valve, which led to the diagnosis of infective endocarditis. The patient was transferred to our hospital for surgery because UCG showed severe tricuspid regurgitation and the vegetation enlarged to 20 mm in size. We resected the posterior apex with vegetation attachment and performed tricuspid valve plasty using the Kay stitches, and the regurgitation disappeared. The patient continued additional antimicrobial therapy and was discharged without any complications at 30 days after operation. Tricuspid valve surgery was considered to be a safe procedure that could be performed at minimally invasive cardiac surgery.