Suzuki Kotaro, Otake Satoshi, Omine Kaito, Watanabe Daisuke, Kawahara Yu, Abe Kazuo
Department of Cardiovascular Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan.
Kyobu Geka. 2020 Nov;73(12):1007-1010.
A 70-year-old man, who had undergone aortic valve neocuspidization using his own pericardium 8 months before, complained of back pain, and was diagnosed with pyrogenic spondylitis. As the result of blood culture, Enterococcus faecalis was found to be the causative bacterium, and antibiotic therapy was started. Six days after admission, hemodynamics collapsed suddenly, and percutaneous cardio-pulmonary support was established. Echocardiography showed severe aortic valve regurgitation, and he was diagnosed with active infective endocarditis. We performed re-do aortic valve neocuspidization using bovine pericardium. There was a tear on the non-coronary cusp and the cusps were thickened because of infection. Aortic annular tissue was not destroyed and we could fix the neo-valve directly to the annulus. After these procedures, severe reduction of antero-septal wall motion was noted, which suggested dissection of the main trunk of the left coronary artery. Coronary artery bypass grafting to the left anterior descending and the circumflex branches was added. The patient came off percutaneous cardio-pulmonary support 5 days after surgery. Although trivial aortic regurgitation remained, he was discharged after 2 months of rehabilitation.
一名70岁男性，8个月前曾使用自身心包进行主动脉瓣新瓣化手术，现主诉背痛，被诊断为化脓性脊柱炎。血培养结果显示粪肠球菌为致病菌，遂开始抗生素治疗。入院6天后，患者突然出现血流动力学崩溃，遂建立经皮心肺支持。超声心动图显示严重主动脉瓣反流，诊断为活动性感染性心内膜炎。我们使用牛心包再次进行主动脉瓣新瓣化手术。非冠状动脉瓣叶有一处撕裂，瓣叶因感染而增厚。主动脉瓣环组织未被破坏，我们能够将新瓣膜直接固定在瓣环上。术后发现前间隔壁运动严重减弱，提示左冠状动脉主干夹层。遂加做左前降支和回旋支冠状动脉搭桥术。患者术后5天脱离经皮心肺支持。虽然仍有轻微主动脉反流，但经过2个月康复后出院。
