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Volume 72, Issue 2 （February 2023）

麻酔 72巻2号（2023年2月発行）

Japanese English

症例報告

術前の経皮的バルーン大動脈弁形成術により重症大動脈弁狭窄症をいったん軽減し大腿骨骨折手術を安全に管理しえた2症例 Preoperative Balloon Aortic Valvuloplasty for Elderly and Super Elderly Patients with Severe Aortic Valve Stenosis Requiring Orthopedics Surgery 大東豊彦 ¹ , 静谷泉 ^1,2 , 伊勢健太郎 ^3,4 , 山田哲也 ⁵ , 横松孝史 ⁶ Toyohiko O’HIGASHI ¹ , Izumi SHIZUYA ^1,2 , Kentaro ISE ^3,4 , Tetsuya YAMADA ⁵ , Takafumi YOKOMATSU ⁶ ¹三菱京都病院麻酔科 ²京都桂病院麻酔科 ³三菱京都病院整形外科 ⁴社会保険大和郡山病院整形外科 ⁵太秦病院整形外科 ⁶三菱京都病院心臓内科 ¹Department of Anesthesia, Mitsubishi Kyoto Hospital ²Department of Anesthesia, Kyoto Katsura Hospital ³Department of Orthopedics, Mitsubishi Kyoto Hospital ⁴Department of Orthopedics, Japan Community Health Care Organization Yamato Koriyama Hospital ⁵Department of Orthopedics, Uzumasa Hospital ⁶Department of Cardiology, Mitsubishi Kyoto Hospital キーワード：重症大動脈弁狭窄症 , 経皮的バルーン大動脈弁形成術 , 超高齢者 , 大腿骨骨折手術 Keyword: severe aortic valve stenosis , balloon aortic valvuloplasty , super elderly patients , orthopedics surgery pp.147-152

発行日 2023年2月10日 Published Date 2023/2/10

DOI https://doi.org/10.18916/masui.2023020013

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要旨

　重症大動脈弁狭窄症（aortic valve stenosis：AS）患者の非心臓手術の周術期死亡率は高い。今回，100歳の超高齢者を含む2症例の重症AS患者の大腿骨骨折に対して，術前に経皮的バルーン大動脈弁形成術（balloon aortic valvuloplasty：BAV）を施行し，いったんASを軽減したあとに，大腿骨骨折手術を安全に管理しえた。

　Super-elderly and elderly females（100 and 88 years old respectively）with right hip fracture were transferred to our hospital. Preoperative examinations revealed severe aortic valve stenosis（AS）with less than 0.5 cm² of aortic valve area and more than 38.7 mmHg of mean pressure gradient and 4.39 m・sec⁻¹ of peak velocity across aortic valve. Preoperative balloon aortic valvuloplasty（BAV）under local anesthesia successfully ameliorated severity of AS. The patients underwent hip surgeries under general anesthesia without invasive monitors. Though hypotension occurred after induction in both cases, blood pressure immediately recovered by administration of low dose phenylephrine and ephedrine. No other significant hemodynamic changes were observed perioperatively. The patients were discharged uneventfully. BAV would be one of the alternatives to perform safe perioperative management of even a super-elderly patient with severe AS.