低侵襲僧帽弁形成術後に生じた肋間肺ヘルニア

Intercostal Pulmonary Hernia after Minimally Invasive Mitral Valve Surgery

本邦での心臓手術において低侵襲手術（minimally invasive cardiac surgery：MICS）が広く普及しているが，利点が多い反面，MICS特有の合併症も多い．その一つに肺ヘルニアがあり，発生率は1.4％といわれており，予防策として肋間閉鎖を行うことが重要である．本例は閉胸時に肋間閉鎖を行っていたが，術後に肺ヘルニアになった．そこでヘルニア修復術時にメッシュプレートを使用し，良好な結果を得られたため報告する．

The patient is a 67-year-old male. He had undergone aortic valve replacement through median sternotomy at our hospital five years ago. He came to our hospital because of respiratory distress since three months ago. Minimally invasive mitral valvuloplasty using right 4th intercostal approach was performed. Postoperative by subcutaneous emphysema worsened with time, and computed tomography （CT） scan revealed a pulmonary hernia, which was urgently repaired with a mesh plate on the same day. Pulmonary hernias after intercostal thoracotomy are rather common in small incision surgery, with a reported incidence of 1.4％. Risk factors include thoracic causing opening larger than 9 cm, obesity, chronic obstructive pulmonary disease, tissue fragility, malnutrition, steroid use, and diabetes mellitus. During mitral valve surgery, the patient had a 9 cm or larger opening, but a thread of 1 mm was placed between the ribs at the time of chest closure. Nevertheless, the thread was torn, and he developed a pulmonary hernia. A mesh plate was applied during repair with good results. Use of a mesh plate should be considered during chest closure in cases with same risk factors.