下腹部の慢性膿皮症を伴う僧帽弁の感染性心内膜炎に対して低侵襲心臓手術を施行した1例

Infective Endocarditis of the Mitral Valve Complicated by Chronic Pyoderma of the Lower Abdomen Treated with Minimally Invasive Cardiac Surgery：Report of a Case

はじめに　慢性膿皮症は多発性の毛包の閉塞病変などに細菌が感染し，炎症反応や肉芽腫性変化が持続する慢性膿瘍性疾患の総称で，経過とともに皮下で交通した瘻孔が多発し，膿汁を伴う病変を形成する疾患である．われわれは下腹部から両鼠径部にかけて本疾患を合併した透析患者の感染性心内膜炎に対して，鼠径部を使用せず右小開胸による低侵襲心臓手術（MICS）を施行したので報告する．

A 45-year-old obese woman on long-term hemodialysis presented with fever and dizziness. Blood cultures revealed Streptococcus agalactiae, and echocardiography demonstrated large mobile vegetations on the mitral valve with preserved valve function. Chronic pyoderma involving the lower abdomen, groin, and vulva was considered the probable source of bacteremia. Because of severe obesity, multiple comorbidities, and extensive skin infection in the inguinal region, minimally invasive cardiac surgery （MICS） via right thoracotomy was performed, avoiding median sternotomy and femoral cannulation. Cardiopulmonary bypass was established using right axillary artery perfusion and jugular and inferior vena cava drainage. Vegetations were successfully removed without mitral valve repair. The postoperative course was uneventful, and no recurrence of infection was observed during two years of follow-up. This case highlights the feasibility of alternative cannulation strategies in MICS for infective endocarditis complicated by extensive skin disease.