免疫抑制状態で発症し急速に進行した感染性心内膜炎に対してCommando手術を施行した1例

Commando Procedure for Rapidly Progressing Infective Endocarditis in Immunosuppressive State：Report of a Case

はじめに　原発不明癌に対する化学療法中，免疫抑制状態で感染性心内膜炎（IE）を発症し，大動脈弁（A弁）と僧帽弁（M弁）および線維性連続（IVF）への感染をきたした症例を経験したので報告する．

A 68-year-old woman with immunosuppressive state following chemotherapy for cancer of unknown primary origin developed infective endocarditis due to methicillin-resistant Staphylococcus aureus （MRSA）. Echocardiography showed shunt blood flow from the aortic annular abscess into the left atrium, which indicated infection of the intervalvular fibrosa （IVF）. She underwent Commando procedure owing to progression of heart failure. The aortic valve, IVF, and anterior leaflet of the mitral valve were resected. The mitral valve was replaced with a bioprosthesis, and a bovine pericardial patch was used to reconstruct the IVF and left atrial roof. Bentall procedure was performed because the infection extended to the sinus of Valsalva, and the ascending aorta was 49 mm in diameter. She had no serious postoperative complications and is currently being followed up at the outpatient clinic. Because infection in these patients are potentially fatal, we believe Commando procedure is effective in spite of high early mortality rate.