大動脈弁位人工弁感染に対するトランスロケーション法による再弁置換術

Aortic Valve Translocation for Severe Prosthetic Valve Endocarditis with Aortic Annular Abscess

人工弁心内膜炎（PVE）の外科的治療は，感染弁の摘出と感染組織のデブリドマン，再弁置換を要する．弁輪への感染が広範囲に及ぶ場合，通常の位置での弁置換は不可能となり，手術手技に工夫を要する．われわれは，全周性の弁輪部膿瘍を認めた大動脈弁位人工弁感染に対し，トランスロケーション法で再弁置換術を施行した1例を経験したので報告する．

We report a case of successful aortic valve translocation in a 71-year-old man with severe prosthetic valve endocarditis and an aortic annular abscess. Six years earlier, the patient had undergone aortic valve replacement for aortic regurgitation and coronary artery bypass grafting to the left anterior descending artery with a saphenous vein. Moreover, 4 years earlier, he had undergone total arch replacement for chronic aortic dissection. He was admitted to our hospital with suspected urinary tract infection. Despite antibiotic therapy, the patient developed a high fever. Transthoracic echocardiography revealed a rocking motion of the prosthetic aortic valve, and an emergency operation was performed. An annular abscess surrounding the prosthetic aortic valve was observed, and the valve was detached. For destruction of the entire aortic annulus, we performed an aortic valve translocation procedure. Revascularization of the left coronary artery was performed by interposing an 8 mm artificial graft between the proximal anastomosis site of the previous venous graft and the composite tube graft. Revascularization of the right coronary artery was performed using a saphenous vein graft. The patient was discharged uneventfully at postoperative day 29 and doing well 1 year after surgery.