ペースメーカ留置後の三尖弁閉鎖不全症に対しリード抜去，三尖弁手術，リードレスペースメーカ留置を同時に施行した1例

Leadless Pacemaker Implantation During Tricuspid Valve Surgery in the Presence of a Permanent Pacemaker with Tricuspid Regurgitation：Report of a Case

はじめに　リード式ペースメーカ留置後の三尖弁閉鎖不全症（TR）は比較的多く，ペースメーカリードの弁尖穿通や接合障害を引き起こすことも指摘されている1）．近年，リードレスペースメーカ（Micra：Medtronic社）が保険償還され，経静脈的に施行されている2）．われわれはリード式ペースメーカ留置後のTRに対して，三尖弁への介入手術とリードレスペースメーカ留置を同時に施行した症例を経験したので報告する．

A 74-year-old man was implanted with a permanent pacemaker for sick sinus syndrome ten years earlier and permanent atrial fibrillation （AF）. Echocardiography indicated progressive severe tricuspid regurgitation （TR） and right ventricular systolic dysfunction with tricuspid annular dilatation and tricuspid valve tethering. The pacemaker lead passing through the tricuspid valve may have contributed to TR, therefore we decided to perform tricuspid valve surgery, pacemaker lead removal, and leadless pacemaker implantation simultaneously during open heart surgery. Tricuspid annuloplasty was performed with the spiral suspension technique. The leadless pacemaker was anchored to the apical septum of the right ventricle through the tricuspid valve with endoscopic guidance, and left atrial appendage closure was performed for permanent AF. The patient was discharged on postoperative day 18 without major complications. He has been doing well with mild TR on transthoracic echocardiography as of three years post-operation.