感染性心内膜炎の外科的治療におけるパルス式洗浄

Surgical Treatment with Pulsed Lavage Irrigation for Infective Endocarditis

パルス式洗浄は，整形外科，救急領域において汚染された軟部組織に対して高圧でデブリの除去や感染防止目的に洗浄を行う方法である．感染性心内膜炎（IE）の外科治療では感染巣の完全除去が重要であるが，自己組織を可能な限り温存し，人工物補塡を最小限にすることも肝要である．IEの広範囲病変例では感染巣除去と自己弁温存の悩ましい場合も少なくない．われわれは，パルス式洗浄をIE 6例の感染巣除去に用い，自己弁温存が可能であり感染再発を認めなかったので報告する．

Introduction：Pulsed lavage irrigation （PLI） is a procedure used to wash contaminated soft tissues and prevent infection in orthopedic surgery. We applicated PLI for surgical treatment of infective endocarditis （IE）.

Subjects and methods：From January 2017 to June 2021, 6 cases underwent surgical treatment IE using PLI. We investigated an efficacy of PLI.

Results：Infected valves were mitral valve in 4 cases, aortic valve in 1 case, and aortic prosthetic valve in 1 case. The performed procedures were mitral valve plasty in 4 cases, aortic valve replacement in 1 case, and 1 removal of vegetation on the aortic prosthetic valve. No recurrence of IE or no deterioration of the native valve or the prosthetic valve was observed in follow-up periods.

Conclusion：PLI was useful for surgical treatment of IE because of no recurrence of IE or no deterioration of native mitral valves or the aortic prosthetic valve.