若年女性に対する二弁置換術後の再大動脈弁置換術によるCommando手術

Commando Procedure for Redo Aortic Valve Replacement in a Young Woman after Double Valve Replacement

Commando手術は活動期感染性心内膜炎や僧帽弁輪高度石灰化に対して弁間線維三角（intervalvular fibrous trigone：IVFT）の切除と再建を行うと同時に，大動脈弁と僧帽弁の二弁置換を行う術式で，1997年に報告された1）．われわれは若年女性の弁輪拡大を必要とする再二弁置換術に対してCommando手術を行い，良好な結果を得たため報告する．

A 29-year-old woman after double valve replacement. She underwent a Commando procedure for aortic valve replacement with annular enlargement due to structural valve deterioration of the bioprosthetic aortic valve and a narrow valve annulus. In the Commando procedure with annular enlargement, the balance between mitral and aortic valve size is important. If the mitral valve is too small, the aortic valve cannot be enlarged sufficiently, and if the mitral valve is too large, left ventricular deformation and left ventricular outflow tract stenosis may occur. Valve sizing should be performed with this in mind.