重症アトピー性皮膚炎による繰り返す感染性心内膜炎に対して右小開胸による僧帽弁形成術を施行した1例

Mitral Valve Plasty for Repetitious Infective Endocarditis Through Small Right Anterior Thoracotomy in a Patient with Severe Atopic Dermatitis：Report of a Case

はじめに　アトピー性皮膚炎は，皮膚バリア機能の低下により感染性心内膜炎（IE）を合併することが多いことが知られており，またアトピー性皮膚炎患者は開心術後縦隔炎のハイリスクであるとの報告もある．われわれは重症アトピー性皮膚炎を有するIE患者に右小開胸による僧帽弁形成術（MICS MVP）を施行し，良好な経過を得たため報告する．

Atopic dermatitis is known to be associated with infective endocarditis due to poorer barrier function of the skin, and it has also been reported that patients with atopic dermatitis are at higher risk of mediastinitis after open heart surgery. A 50-year-old man with recurrent episodes of Staphylococcus aureus infection presented to the hospital with a chief complaint of fever and shortness of breath. Close examination revealed mitral regurgitation due to infective endocarditis, and the patient was advised to undergo surgery. Echocardiography showed vegetation on the anterior leaflet of the mitral valve with a regurgitant volume of 63 ml. This patient with severe atopic dermatitis underwent mitral valve plasty through small right anterior thoracotomy. His wound was treated deliberately, and he steadily recovered without wound infection. This surgical approach is a useful alternative in patients at high risk of surgical site infection.