重症虚血性僧帽弁逆流に対し乳頭筋吊り上げ手術を施行した1手術例

A Successful Case of Papillary Muscle Relocation for Severe Ischemic Mitral Regurgitation

要旨　患者は60歳，男性．糖尿病，脂質異常症で加療中であった．深夜になり突然の起坐呼吸を自覚したため救急来院された．心臓超音波検査および冠動脈造影検査を施行したところ，虚血性心筋症に伴う重症僧帽弁閉鎖不全症の診断を得，手術目的で紹介となった．

　手術は，弁下組織温存とtethering改善目的で，僧帽弁輪形成術に加え，人工腱索を用い，乳頭筋吊り上げ手術を施行した．術後経過は良好で，術後心臓超音波検査においても僧帽弁逆流の再発を認めず，心臓リハビリテーションを施行した後，術後21日目で軽快退院された．

　虚血性心筋症患者に伴った重症僧帽弁逆流に対する手術については依然，議論の余地がある．今回われわれは，重症虚血性僧帽弁逆流症に対して，乳頭筋吊り上げ手術を施行し良好な結果を得た1手術例を経験したので，文献を踏まえ報告する．

　A 60-year-old man was admitted to our hospital with complaints of worsening orthopnea. Doppler echocardiography exhibited severe mitral valve regurgitation(MR)and coronary angiography demonstrated three vessel diseases. Because of tethering of the mitral valve, we performed mitral valve annuloplasty concomitantly with papillary muscle relocation procedure. He recovered well and was discharged 21 days after surgery. Postoperative echocardiography had not either exhibited recurrent mitral valve insufficiency or elevation of mitral mean gradient.

The development of functional MR has a negative impact on the survival of patients with ischemic cardiomyopathy. Survival rate, however, is still disappointing. This limited long-term survival has made it difficult to assess the durability of mitral valve repair, because of which the optimal surgical strategy for treating this condition remains unclear.

This report describes our successful experience with mitral valve annuloplasty concomitantly with papillary muscle relocation procedure.