大動脈基部膿瘍を伴う人工弁感染性心内膜炎に対する根治的膿瘍搔爬

Prosthetic Valve Endocarditis with Aortic Root Abscess That Was Controlled Infection by Radical Debridement

大動脈弁置換後の人工弁感染性心内膜炎（prosthetic valve endocarditis：PVE）では，弁輪部膿瘍および弁周囲組織の破壊のため左室流出路から大動脈基部にかけての正常な構造が失われ，再弁置換術が困難となる場合がある．本稿では，根治的な膿瘍搔爬とパッチ形成による基部形成術を行うことにより良好な結果を得られた2例を報告する．

In cases of prosthetic valve endocarditis following aortic valve replacement （AVR）, destruction of perivalvular tissue and discontinuity in the left ventricular outflow tract can complicate repeat valve replacement. We obtained favorable outcomes with radical resection of aortic root abscess and subsequent pericardial patch reconstruction in two cases. The first case was a 52-year-old woman who underwent patch closure of ventricular septal defect, AVR, and coronary artery bypass, one month ago. She presented with vegetations attached to the prosthetic valve and the patch. The second case was a 46-year-old male who underwent AVR for infective endocarditis. A month later, he developed heart failure due to paravalvular leakage, and computed tomography （CT） scan showed a pseudoaneurysm beneath the prosthetic valve. In both patients, surgical intervention included radical debridement of infected tissue, patch reconstruction of the defect, and AVR. Both patients were free from recurrence of infective endocarditis post-operatively.