左心低形成症候群に対する三尖弁形成におけるCarpentier変法

Modified Carpentier Technique is Useful Method for Tricuspid Regurgitation in Hypoplastic Left Heart Syndrome

左心低形成症候群（HLHS）において外科的治療を要する三尖弁逆流（TR）は25％程度に発症し，予後不良因子とされている1）．われわれは，Ⅲ度のTRを呈したHLHSに対して，上下大静脈肺動脈吻合術（TCPC）と同時に施行した三尖弁形成術（TVP）において，Carpentier変法が有用であった症例を経験したので，報告する．

Management of tricuspid regurgitation （TR） before right ventricular dysfunction is critical in patients with hypoplastic left heart syndrome （HLHS）；however, appropriate tricuspid valvuloplasty （TVP） is challenging. We report a TVP technique for TR in a 4-year-old girl with HLHS, who had undergone Norwood operation, bidirectional cavopulmonary shunt, and TVP. Preoperative echocardiography revealed the etiology of TR as anterior leaflet prolapse, annulus dilatation, and relative tethering of the septal leaflet. We performed surgical reconstruction of the anterior leaflet with artificial chordae. Before annuloplasty, the posterior leaflet and a part of the septal leaflet were detached from the annulus with a 1 mm margin using the Key-Reed technique. Furthermore, the posterior leaflet was slid to augment the septal leaflet. We managed to regulate the TR by enlarging the septal leaflet, thus increasing the coaptation zone. We believe that this technique will be useful for TR with annulus dilatation in HLHS.