虚血性心筋症に対する僧帽弁形成術

Mitral Valve Repair in a Patient With Ischemic Cardiomyopathy

虚血性心筋症（ischemic cardiomyopathy：ICM）に伴う僧帽弁逆流（ischemic mitral regurgitation：IMR）はリモデリングした左室によるtetheringが主な原因である．弁尖や弁下組織自体に病変は少なく，左室の形態変化による影響が大きいため形成術は複雑になり，腱索を温存した弁置換術のほうが逆流制御という点においては優位な症例もある．われわれは重症IMRに対する僧帽弁形成術例の遠隔期成績も含め報告する．

In patients with severe ischemic mitral regurgitation, annuloplasty alone results in early recurrence due to deterioration in tethering. Therefore, additional procedures targeting the subvalvular tissue, such as approximation or suspension of papillary muscle, have been considered. Ischemic mitral regurgitation mainly results from tethering due to left ventricular enlargement, with varying severity among cases and difficult prediction of reverse remodeling. Residual mitral regurgitation affects prognosis, necessitating reliable regurgitation control during mitral repair procedure. In some cases, valve replacement with chordal preservation may be preferable. We performed mitral valve repair for severe ischemic mitral regurgitation due to leaflet tethering. The patient was a 75-year-old male who had an acute myocardial infarction 10 years prior, which led to the progression of ischemic cardiomyopathy. Anterior leaflet augmentation using an autologous pericardial patch, suspension of the papillary muscles, and implantation of an artificial ring were performed. Six years postoperatively, the mitral valve remains in good condition and left ventricular reverse remodeling is favorable, with no heart failure observed. This procedure is considered an effective surgical option for ischemic mitral regurgitation and is hereby reported.