自己心膜による大動脈弁再建術後の感染性心内膜炎に対するウシ心膜を使用した再弁再建術の1例

Re-operation Using Bovine Pericardium for Infective Endocarditis after Aortic Valve Neocuspidization；Report of a Case

はじめに　自己心膜を用いた大動脈弁再建術（AVneo）は，Ozakiらにより報告され，当科では2015年から採用している．われわれは，AVneo術後の感染性心内膜炎（IE）に対し，再手術を行った症例を経験したので報告する．

A 70-year-old man, who had undergone aortic valve neocuspidization using his own pericardium 8 months before, complained of back pain, and was diagnosed with pyrogenic spondylitis. As the result of blood culture, Enterococcus faecalis was found to be the causative bacterium, and antibiotic therapy was started. Six days after admission, hemodynamics collapsed suddenly, and percutaneous cardio-pulmonary support was established. Echocardiography showed severe aortic valve regurgitation, and he was diagnosed with active infective endocarditis. We performed re-do aortic valve neocuspidization using bovine pericardium. There was a tear on the non-coronary cusp and the cusps were thickened because of infection. Aortic annular tissue was not destroyed and we could fix the neo-valve directly to the annulus. After these procedures, severe reduction of antero-septal wall motion was noted, which suggested dissection of the main trunk of the left coronary artery. Coronary artery bypass grafting to the left anterior descending and the circumflex branches was added. The patient came off percutaneous cardio-pulmonary support 5 days after surgery. Although trivial aortic regurgitation remained, he was discharged after 2 months of rehabilitation.