老年期の大動脈弁狭窄兼閉鎖不全症の手術中に診断がついた大動脈四尖弁の1例

Quadricuspid Aortic Valve Diagnosed During Surgery in an Elderly Patient with Aortic Stenosis and Regurgitation：Report of a Case

はじめに　大動脈四尖弁はまれな疾患であり，その多くが単独の先天性心疾患として，時には複合心臓疾患の一つとして指摘される．また，成人までに大動脈弁閉鎖不全症（AR）として指摘されることが多く，近年では画像診断の進歩により術前に詳細な形態を評価することが可能となっている．われわれは，術前検査では大動脈四尖弁を診断することができなかった高齢者の大動脈弁狭窄兼閉鎖不全症（aortic valve stenosis and regurgitation：ASR）に対し，大動脈弁置換術（aortic valve replacement：AVR）を施行した症例を経験したので報告する．

We report case details of a quadricuspid aortic valve that was diagnosed during surgery in an 82-year-old male with aortic valve stenosis and regurgitation. He had been treated for heart failure with atrial fibrillation, and aortic valve dysfunction. Sinus rhythm was restored after second catheter ablation for atrial fibrillation. However, heart failure symptoms associated with aortic valve stenosis and regurgitation remained, and surgical treatment was planned. Intraoperative findings revealed a quadricuspid aortic valve that was not diagnosed during preoperative examination. It can be difficult to detect a quadricuspid aortic valve on preoperative cardiac echocardiography if valve leaflets are calcified and poorly mobile. It is important to match the commissure at one location with that of the prosthetic valve and sew the prosthetic valve in a manner that does not occlude the orifice of the coronary artery.