左房への大動脈-心内腔交通症を合併した大動脈弁位感染性心内膜炎の1例

Aortic Valve Endocarditis complicated by Aorto-cavitary Fistula to the Left Atriam Report of a Case

はじめに　大動脈弁位の感染性心内膜炎（IE）では10％前後に弁輪部膿瘍が認められ1，2），同部に心腔間穿孔が合併した際に致死率は非常に高くなるとされる3）．われわれは，大動脈弁位IEにより大動脈-僧帽弁輪移行部（AMC）で穿孔をきたし，左房への大動脈-心内腔交通症（ACF）を合併した大動脈弁閉鎖不全（AR）例に対し，外科的治療を行い良好な結果を得たので報告する．

Aorto-cavitary fistula （ACF） is a rare and serious complication of aortic valve endocarditis, which frequently requires high risk surgical repair. A 78-year-old man under cardioventilatory support was referred to our hospital. Aortic valve regurgitation with ACF to the left atrium, caused by endocarditis, was demonstrated by transthoracic echocardiography. Under ongoing support, surgery was suspended for two weeks after referral, because subacute cerebral infarction was detected. Then we performed aortic valve replacement, mitral valve annuloplasty and closure of the aorto-left atrial communication. The perforation was sutured directly, with glutalaldehyde-treated autologous-pericardium support, on both the aorta and left atrium side. His hemodynamic condition improved dramatically after operation. The patient was discharged from our institute on the 45th-postoperative-day.