Barlow病による僧帽弁閉鎖不全症と三尖弁閉鎖不全症に対する二弁形成術の1例

Double Valves Repair for Mitral and Tricuspid Regurgitation due to Barlowʼs Disease：Report of a Case

はじめに　Barlow病による僧帽弁閉鎖不全症（MR）は弁尖の高度な粘液性変性による肥厚と拡大，腱索延長および弁輪拡大を特徴とし，弁形成術の難易度は高い．近年，僧帽弁形成術の治療成績の向上に伴い，Barlow病に起因する弁膜症に関するさまざまな術式や遠隔成績が報告されている．本稿では，Barlow病によるMRと三尖弁閉鎖不全症（TR）に対する二弁形成術を施行した症例について報告する．

A 75-year-old man with mitral regurgitation （MR） and tricuspid regurgitation （TR） caused by Barlowʼs disease was referred to our hospital. He had a history of persistent atrial fibrillation. Echocardiography showed severe MR with bi-leaflet billowing and functional TR. Cardiac index was 1.08 l/min/m2 without pulmonary hypertension. Through superior trans-septal approach, mitral valve was repaired by annuloplasty only using a partial ring so as not to induce systolic anterior movement. On the other hand, tricuspid valves showed severe billowing and prolapse, both of which were unexpected. Following tricuspid annuloplasty, we implanted two pairs of artificial chordae to both the anterior and posterior leaflet for leafletsʼ height reduction, thus TR was successfully controlled. There was no recurrence of significant MR and TR at three years follow-up.