急激な心不全の増悪・寛解を繰り返す僧帽弁閉鎖不全症に対する僧帽弁置換術

Mitral Valve Replacement for Eclipsed Mitral Regurgitation with Multiple Episodes of Acute Exacerbation and Remission

Eclipsed mitral regurgitation（EMR）は比較的新しい概念で，駆出率が正常で，既存の左室リモデリングがなく，冠状動脈の狭窄がないにもかかわらず，突然の可逆的な僧帽弁尖のtentingとその後の急激な僧帽弁閉鎖不全症（MR）および急性心不全を起こす病態として，2008年にAvierinosら1）が報告した．EMRの報告は少なく，その増悪の機序や治療法など不明な点が多い．われわれは，原因不明の急性心不全を繰り返していたEMRの患者を僧帽弁置換術（MVR）で治療した経験を報告する．

Eclipsed mitral regurgitation is a relatively new disease concept reported in recent years, of which is not fully elucidated. A 73-year-old female had repeated episodes of heart failure of unknown cause. During cardiac catheterization and echocardiography performed, mitral regurgitation suddenly worsened and improved in a few minutes. The patient was diagnosed as having eclipsed mitral regurgitation with multiple episodes of acute exacerbation and remission. Although mechanism of exacerbation remains unclear, morphological change of the left ventricle is likely to be a major cause, and mitral valve replacement seems better than plasty for prevention of recurrent heart failure. The patient underwent valve replacement using a bioprothesis and was discharged from the hospital on her own 24 days after surgery. Six months after the operation, she has been doing well without recurrence of heart failure.