Enomoto Yoshinori, Mogi Kenji, Sakurai Manabu, Takahara Yoshiharu
Department of Cardiovascular Surgery, Kimitsu Chuo Hospital, Kisarazu, Japan.
Kyobu Geka. 2020 Nov;73(12):991-995.
We report a case of successful aortic valve translocation in a 71-year-old man with severe prosthetic valve endocarditis and an aortic annular abscess. Six years earlier, the patient had undergone aortic valve replacement for aortic regurgitation and coronary artery bypass grafting to the left anterior descending artery with a saphenous vein. Moreover, 4 years earlier, he had undergone total arch replacement for chronic aortic dissection. He was admitted to our hospital with suspected urinary tract infection. Despite antibiotic therapy, the patient developed a high fever. Transthoracic echocardiography revealed a rocking motion of the prosthetic aortic valve, and an emergency operation was performed. An annular abscess surrounding the prosthetic aortic valve was observed, and the valve was detached. For destruction of the entire aortic annulus, we performed an aortic valve translocation procedure. Revascularization of the left coronary artery was performed by interposing an 8 mm artificial graft between the proximal anastomosis site of the previous venous graft and the composite tube graft. Revascularization of the right coronary artery was performed using a saphenous vein graft. The patient was discharged uneventfully at postoperative day 29 and doing well 1 year after surgery.
我们报告一例71岁男性成功进行主动脉瓣移位术的病例，该患者患有严重的人工瓣膜心内膜炎和主动脉瓣环脓肿。6年前，患者因主动脉瓣反流接受主动脉瓣置换术，并使用大隐静脉进行左前降支冠状动脉搭桥术。此外，4年前，他因慢性主动脉夹层接受了全弓置换术。他因疑似尿路感染入院。尽管进行了抗生素治疗，患者仍出现高热。经胸超声心动图显示人工主动脉瓣有摇摆运动，遂进行急诊手术。观察到人工主动脉瓣周围有瓣环脓肿，瓣膜已脱离。由于整个主动脉瓣环被破坏，我们进行了主动脉瓣移位手术。通过在先前静脉移植物的近端吻合部位与复合血管移植物之间插入一段8毫米的人工移植物，实现左冠状动脉再血管化。使用大隐静脉移植物进行右冠状动脉再血管化。患者术后第29天顺利出院，术后1年情况良好。
