大動脈炎症候群に併発した急性僧帽弁閉鎖不全症に対する心室細動下僧帽弁形成術

Mitral Valve Repair under Ventricular Fibrillation for Acute Mitral Valve Regurgitation in a Patient with Aortitis Syndrome

大動脈炎症候群は大動脈およびその分枝に高度な石灰化や狭窄・閉塞をきたす大血管炎であり，開心術の際には工夫を要する．われわれは，急性僧帽弁閉鎖不全症（MR）を発症した大動脈炎症候群の1例に対し，緊急で心室細動下僧帽弁形成術を行い救命しえたので報告する．

A 73-year-old woman with a history of aortitis syndrome was referred to our hospital presenting with congestive heart failure caused by acute severe mitral regurgitation due to posterior leaflet prolapse. Upon admission, the patient fell into shock state while undergoing an examination. Medical treatment including mechanical ventilation could not alleviate circulatory collapse, so emergency surgery was performed on the day of admission. Severe calcification of the ascending aorta and severe stenosis or occlusion of the aortic arch vessels resulted from the patient’s aortitis syndrome precluded aortic cannulation and aortic clamp. Therefore, mitral valve repair was performed under ventricular fibrillation at moderate hypothermia. Surgery was successful, and the patient recovered well without any cerebral complications after the surgery.