高度僧帽弁輪石灰化例に対する僧帽弁置換術の1例

Mitral Valve Replacement in a Patient with Severe Mitral Annular Calcification：Report of a Case

はじめに　高度僧帽弁輪石灰化（mitral annular calcification：MAC）を伴う僧帽弁置換術（mitral valve replacement：MVR）において，過度な石灰化処理は左室破裂などの重篤な合併症を招く可能性があり，注意を要する．われわれは後尖組織を温存し，MACの処理を最小限にとどめ，ウシ心膜パッチによる弁輪補と人工弁縫着の方法を工夫することで，安全にMVRを施行しえたので報告する．

Mitral annular calcification （MAC） increases the risk of left ventricular rupture during mitral valve replacement （MVR）. We report an 81-year-old woman with severe MAC who underwent MVR with preservation of the posterior leaflet and subvalvular apparatus, combined with selective annular debridement using an ultrasonic surgical aspirator and annular reinforcement with a bovine pericardial patch. The valve prosthesis was sewn into place with special attention to suture needle position. Our maneuver enabled safe calcification removal and implantation of an adequately sized prosthesis without left ventricular rupture or paravalvular leakage. Postoperative left ventricular function was well preserved, and the prosthetic valve showed good performance. This technique may reduce the risks of left ventricular rupture and prosthesis-patient mismatch during MVR in patients with severe MAC.