記述言語：英語  

A 59-year-old man with no prior neurological deficits developed a massive stroke during the repair of a double-barreled acute type A aortic dissection with major entry in the ascending aorta and an occluded brachiocephalic artery. As right cerebral ischemia was alleviated by the circle of Willis, the patient was alert and conscious preoperatively. Nevertheless, the thrombus in the right carotid artery induced a severe postoperative right cerebral embolism. In conclusion, occlusion of the carotid artery is a risk factor of postoperative severe stroke, even in patients without neurological symptoms preoperatively.

DOI： 10.1177/2050313X211025215

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記述言語：日本語   出版者・発行元：(一社)日本胸部外科学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Excessive prostaglandin E2 production is a hallmark of abdominal aortic aneurysm (AAA). Enhanced expression of prostaglandin E2 receptor EP4 (prostaglandin E receptor 4) in vascular smooth muscle cells (VSMCs) has been demonstrated in human AAAs. Although moderate expression of EP4 contributes to vascular homeostasis, the roles of excessive EP4 in vascular pathology remain uncertain. We aimed to investigate whether EP4 overexpression in VSMCs exacerbates AAAs. Approach and Results: We constructed mice with EP4 overexpressed selectively in VSMCs under an SM22α promoter (EP4-Tg). Most EP4-Tg mice died within 2 weeks of Ang II (angiotensin II) infusion due to AAA, while nontransgenic mice given Ang II displayed no overt phenotype. EP4-Tg developed much larger AAAs than nontransgenic mice after periaortic CaCl2 application. In contrast, EP4fl/+;SM22-Cre;ApoE-/- and EP4fl/+;SM22-Cre mice, which are EP4 heterozygous knockout in VSMCs, rarely exhibited AAA after Ang II or CaCl2 treatment, respectively. In Ang II-infused EP4-Tg aorta, Ly6Chi inflammatory monocyte/macrophage infiltration and MMP-9 (matrix metalloprotease-9) activation were enhanced. An unbiased analysis revealed that EP4 stimulation positively regulated the genes binding cytokine receptors in VSMCs, in which IL (interleukin)-6 was the most strongly upregulated. In VSMCs of EP4-Tg and human AAAs, EP4 stimulation caused marked IL-6 production via TAK1 (transforming growth factor-β-activated kinase 1), NF-κB (nuclear factor-kappa B), JNK (c-Jun N-terminal kinase), and p38. Inhibition of IL-6 prevented Ang II-induced AAA formation in EP4-Tg. In addition, EP4 stimulation decreased elastin/collagen cross-linking protein LOX (lysyl oxidase) in both human and mouse VSMCs. CONCLUSIONS: Dysregulated EP4 overexpression in VSMCs promotes inflammatory monocyte/macrophage infiltration and attenuates elastin/collagen fiber formation, leading to AAA exacerbation.

DOI： 10.1161/ATVBAHA.120.314297

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BioMed Central Ltd.  

Background: Tracheo-innominate artery fistula (TIF) is a rare but fatal complication occurring after tracheotomy. Brachiocephalic trunk transection, one of the surgical treatments for TIF, is mostly associated with a full or partial median sternotomy. We describe a case of TIF with continuous bleeding, which was successfully treated with brachiocephalic trunk transection through a collar incision without the need for median sternotomy. Case presentation: Case 1. An 18-year-old man was referred to our hospital with bleeding from a tracheal stoma, which had ceased prior to admission. TIF was suspected after examination. Innominate artery transection was performed through a collar incision. TIF was not revealed when we cut the innominate artery anterior wall open
therefore, we opted for preventive surgical intervention. The post-operative course was uneventful, and the patient was asymptomatic at the 3-year follow-up. Case 2. A 14-year-old male patient was admitted to our hospital with bleeding from a tracheal stoma, and TIF was suspected after examination. There was persistent bleeding when the cuff of the tracheotomy tube was deflated. Brachiocephalic trunk transection was performed through a collar incision using balloon occlusion. The post-operative course was uneventful, and rebleeding has not occurred 2 years later. Conclusions: Brachiocephalic trunk transection without any median sternotomy may offer the benefits of post-operative infection prevention. In patients with suspected continuous bleeding, using a balloon catheter may be a safe and effective method of treatment.

DOI： 10.1186/s13019-020-1080-y

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記述言語：英語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：英語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：英語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：英語  

DOI： 10.1016/j.jvs.2018.11.040

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本心臓血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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DOI： 10.1007/s11748-018-1014-y

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記述言語：日本語   出版者・発行元：日本胸部外科学会-関東甲信越地方会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：BioMed Central Ltd.  

Background: It is well known that there are major differences between the Japanese and Western population regarding the incidence of ischemic heart disease and stroke. The purpose of this study was to evaluate differences of patients' characteristics between Belgian and Japanese cohort with acute type A aortic dissection. Methods: In 487 patients (297 male patients, mean age 61.9 ± 12.2 yrs) who underwent surgery for acute type A aortic dissection, baseline preoperative and intraoperative data were collected. Belgian patients (n = 237) were compared to Japanese patients (n = 250). Clinical data included patient demographics, history, status at presentation, imaging study results and intraoperative findings. Results: The Japanese cohort had significantly more women (48.8% vs. 28.7%, p &lt
0.0001), lower BMI (24.2 vs. 26.4, p &lt
0.0001) and lower prevalence of hypertension (49.2% vs. 65.8%, p = 0.0002). More DeBakey type I dissections and less type III dissections with retrograde extension were reported in Belgium than in Japan (77.2% vs. 48.4%, p &lt
0.0001, 3.4% vs. 38.7%, p &lt
0.0001, respectively). More entries were found in the ascending aorta (78.5% vs. 58.5%, p &lt
0.0001) and aortic arch (24.9% vs. 13.7%, p = 0.0018) in Belgian patients than in Japanese patients, who had more entries in the descending aorta or undetected entries. Conclusions: In acute type A aortic dissection, Belgian patients reveal striking differences from Japanese patients regarding gender distribution, entry tear location and type of dissection. Japanese women are more likely to develop acute type A aortic dissection than Belgian women. (234 words).

DOI： 10.1186/s13019-018-0782-x

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.14814/phy2.13878

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DOI： 10.1016/j.jtcvs.2018.02.007

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DOI： 10.1152/ajpheart.00329.2018

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

To evaluate and compare the clinical outcomes and hospital costs of using sutureless aortic valves vs conventional stented aortic valves.
Between 2007 and 2011, 52 elderly patients undergoing aortic valve replacement for aortic stenosis in our center had a sutureless valve inserted. From among 180 patients who had a stented valve inserted during the same period, 52 patients were matched to the sutureless group, based on age, gender, and operation type. We compared clinical outcomes and hospital costs between the two groups.
The sutureless group had a higher Euroscore (logistic Euroscore I) risk (12.8 vs 9.7; p = 0.02), with significantly shorter aortic cross-clamp (ACC) time (p < 0.01), cardiopulmonary bypass (CPB) time (p < 0.01), intensive care unit stay (p < 0.01), intubation time (p < 0.01), and overall hospital stay (p = 0.05). The sutureless group also revealed a significant hospital cost saving of approximately 8200a,notsign (p = 0.01).
The clinical and hemodynamic outcomes of using the sutureless bioprosthesis were excellent. The reduced ACC and CPB times had a favorable effect on the duration of intubation and intensive care stay, resulting not only in faster recovery and discharge home, but also in a significant hospital cost reduction.

DOI： 10.1007/s00595-017-1516-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：JAPANESE CIRCULATION SOC  

Background: Stanford type A acute aortic dissection (A-AAD) extends to the brachiocephalic branches in some patients. After ascending aortic replacement, a remaining re-entry tear in the distal brachiocephalic branches may act as an entry and result in a patent false lumen in the aortic arch. However, the effect of brachiocephalic branch re-entry concomitant with A-AAD remains unknown.
Methods and Results: Eighty-five patients with A-AAD who underwent ascending aortic replacement in which both preoperative and postoperative multiple-detector computed tomography (MDCT) scans could be evaluated were retrospectively studied. The presence of a patent false lumen in at least one of the brachiocephalic branches on preoperative MDCT was defined as brachiocephalic branch re-entry, and 41 patients (48%) had this. Postoperatively, 47 of 85 (55%) patients had a patent false lumen in the aortic arch. False lumen remained patent after operation in 34 out of the 41 (83%) patients with brachiocephalic branch re-entry, as compared to that in 13 of the 44 (30%) patients without such re-entry (P<0.001). Brachiocephalic branch re-entry was a significant risk factor for a late increase in the aortic arch diameter greater than 10 mm (P=0.047).
Conclusions: Brachiocephalic branch re-entry in patients with A-AAD is related to a patent false lumen in the aortic arch early after ascending aortic replacement and is a risk factor for late aortic arch enlargement.

DOI： 10.1253/circj.CJ-16-0462

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

今回われわれは，極めて稀な僧帽弁弁尖の外傷性裂傷による僧帽弁閉鎖不全の1手術例を報告する．症例は42歳の男性．3年前に3階から転落，顔面骨折・骨盤骨折・脳挫傷・肺挫傷および外傷性大動脈解離を発症し，当院に入院した．受傷直後の僧帽弁の逆流は軽度であり，循環動態の異常は認められなかった．入院加療を行い，受傷後18日目に全身状態は改善し退院した．経過観察中，受傷2年後に労作時の息切れが発現し，経胸壁心臓超音波検査にて僧帽弁閉鎖不全の増悪を認めた．受傷3年後，僧帽弁形成術を施行した．術中所見では僧帽弁の前交連側前尖（A1）に裂傷を認め，これによる重症僧帽弁閉鎖不全と考えられた．裂傷部の弁尖縫合により逆流は消失し，術後労作時の息切れも消失した．

DOI： 10.3919/jjsa.77.535

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

今回われわれは，術前心肺停止を発症した冠動脈瘤破裂の1手術例を経験したので報告する．症例は47歳，女性．タクシー乗車中に意識消失し，救急搬送となった．救急車内で意識回復，当院救命センターを受診したが診察時に心肺停止となった．心臓超音波検査にて心タンポナーデを認め直ちに心嚢ドレナージを施行，自己心拍再開を得た．脳低温療法を施行後精査にて，右冠動脈領域に最大径5mmおよび左冠動脈領域に最大径8mmの冠動脈瘤を認め，両側冠動脈肺動脈瘻を形成していた．心肺停止の原因は冠動脈瘤の破裂と判断，人工心肺下に瘤切除，冠動脈肺動脈瘻閉鎖術を施行した．術中小さな冠動脈瘤の同定にICG navigation system （photodynamic Eye<SUP>&reg;</SUP>）が有用であった．術後12日目に軽快退院した．

DOI： 10.3919/jjsa.77.303

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Coronary subclavian steal syndrome associated with upper extremity arteriovenous fistula is an uncommon but potentially life-threatening condition. We present a case of a 65-year-old male on hemodialysis with a left upper extremity arteriovenous fistula who underwent coronary revascularization involving bypass with the left internal thoracic artery to the left anterior descending artery. Intraoperative transit-time graft flow measurements and fluorescence imaging showed a reversed flow in the left internal thoracic artery, and the left internal thoracic artery was successfully converted as a free graft from the ascending aorta to the left anterior descending artery. doi: 10.1111/jocs.12444 (J Card Surg 2015;30:154-156)

DOI： 10.1111/jocs.12444

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

BackgroundWe evaluated clinical outcomes of thoracic endovascular aortic repair (TEVAR) for ruptured descending thoracic aortic aneurysm (rDTAA).
MethodsTwenty-three patients with rDTAA (mean age, 76.88.8 years) underwent TEVAR at our center between January 2008 and April 2013.
ResultsIn twenty-three patients, five patients (21.7%) were in shock before surgery. Technical success was achieved in 21 patients. After TEVAR, retrograde Type A aortic dissection occurred in one patient, Type I endoleak in one patient, and Type II endoleak in three patients. The 30-day mortality rate was 4.3% (n=1), and there were five in-hospital deaths (21.7%). Six patients (26.1%) developed cerebral complications and two patients suffered from paraplegia. In the late phase, four patients died because of the following aortic events: re-rupture in one patient, rupture of another untreated aneurysm in two patients, and esophageal perforation in one patient.
ConclusionsTEVAR is associated with relatively low early morbidity and mortality and can be performed in older and high-risk patients. However, because aortic events during follow-up after TEVAR are not rare, we recommend close follow-up and application of early and aggressive reintervention. doi: 10.1111/jocs.12499(J Card Surg 2015;30:163-169)

DOI： 10.1111/jocs.12499

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS INC  

OBJECTIVES: Intramural haematoma is defined pathologically as aortic dissection without an intimal tear. We therefore believe that this term is inappropriate as an acute clinical diagnosis, and instead, use the term 'thrombosed-type acute aortic dissection'. We compared the features of thrombosed-type acute aortic dissection with those of classic dissection.
METHODS: Thrombosed type was defined as aortic dissection without flow in the false lumen of the aorta on contrast-enhanced computed tomography. Surgery was indicated for all cases of type A acute aortic dissection, and central repair operations were performed in 509 patients. We retrospectively studied these patients' surgical records.
RESULTS: Three hundred and forty-four patients (68%) had classic dissection, and 165 (32%) had thrombosed type. Thrombosed type was associated with a significantly higher mean age (69 vs 60 years, P &lt; 0.01), a higher incidence of cardiac tamponade (45 vs 28%, P &lt; 0.01) and a lower incidence of malperfusion (6 vs 35%, P &lt; 0.01) than classic dissection. Entry tears were located in the ascending aorta and the arch in 74 patients (45%) with thrombosed type. Since 2007, an intimal tear has been confirmed intraoperatively or on computed tomography in 39 (78%) of 50 patients with thrombosed-type aortic dissection. Mortality was significantly lower in patients with thrombosed-type dissection (6%) than in those with classic dissection (13%, P = 0.02).
CONCLUSIONS: Most cases of intramural haematoma are acute aortic dissections with an intimal tear without re-entry. Intramural haematoma should be referred to as thrombosed-type acute aortic dissection. Thrombosed type can be easily diagnosed on contrast-enhanced computed tomography and has features distinct from those of classic dissection. Our classification may be useful for the diagnosis of these types of aortic dissection.

DOI： 10.1093/ejcts/ezt040

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS INC  

OBJECTIVES: The purpose of this study was to evaluate the clinical outcomes of emergency surgery for acute type B aortic dissection with rupture and to compare results between open surgery and thoracic endovascular aortic repair (TEVAR).
METHODS: Two hundred and ninety-four patients with acute type B aortic dissection were admitted to our hospital between January 2000 and March 2012. At presentation, 30 (10%) patients had rupture (20 men, 10 women; mean age, 71 +/- 15 years), among whom 23 underwent emergency surgery: 9 underwent TEVAR and 14 underwent open surgery. The objective of TEVAR was closure of the primary entry site and the secondary tear site in the descending thoracic aorta.
RESULTS: In the TEVAR group, technical success was achieved: the primary entry site was closed, and bleeding was controlled in all 9 patients. There was no operative death, and 1 (13%) patient had cerebral infarction. In the open surgery group, 2 (14%) patients died during hospitalization, and 4 (29%) had cerebral infarction in the acute phase. Hospitalization tended to be longer in the open surgery group than in the TEVAR group. The overall survival rate at 1 year was 71 +/- 17% in the TEVAR group and 86 +/- 9% in the open surgery group (P = 0.89).
CONCLUSIONS: TEVAR for acute type B aortic dissection with rupture could be performed with relatively low morbidity and mortality, with no significant difference when compared with open surgery. The main objective of TEVAR for acute type B aortic dissection with rupture is control of bleeding, which can be achieved by closing the primary entry site and the secondary tear site in the descending thoracic aorta. If anatomically feasible and performed immediately, TEVAR is the treatment of choice for acute type B aortic dissection with rupture because it is less invasive than open surgery.

DOI： 10.1093/ejcts/ezs703

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL TRIBUNE INC  

Purpose: To study mid-term outcomes in patients admitted to receive treatment for acute type B aortic dissection.
Methods: The study group comprised 229 patients with acute type B aortic dissection treated between January 2000 and July 2010. 128 patients had a thrombosed false lumen, and 101 had a patent false lumen.
Results: In the thrombosed group, 6 had rupture, 4 had malperfusion, and 118 had no complications. There were 5 early deaths (3.9%). In the patent group, 12 had rupture, 19 had malperfusion, and 70 had no complications. There were 6 early deaths (5.9%). Overall survival rates in the thrombosed group and the patent group were 94.7 +/- 2.2% and 90.2 +/- 3.2% at 1 year, and 84.3 +/- 4.6% and 85.9 +/- 4.3% at 5 years (p = 0.892), respectively. Aorta-related event-free rates were 85.6 +/- 3.4% and 48.3 +/- 5.5% at 1 year, and 76.0 +/- 5.1% and 35.2 +/- 7.2% at 5 years (p &lt;0.001), respectively.
Conclusions: The incidences of rupture and malperfusion during the acute phase were higher in the patent group compared with the thrombosed group. At the late period, although the aorta-related event rate was higher in the patent group, the survival rate did not differ between two groups. Close follow-up and aggressive intervention strategy of the patent group may result comparable outcomes with the thrombosed group.

DOI： 10.5761/atcs.oa.12.02077

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記述言語：日本語   出版者・発行元：Japan Surgical Association  

症例は81歳，男性．弓部大動脈瘤の手術予定であったが急性心不全で入院となった．経過中に連続性雑音を聴取するようになり，胸部造影CT検査にて弓部大動脈瘤の左肺動脈穿破と診断され当院転院となった．転院3日後に弓部置換および穿孔部閉鎖術，CABGを施行したが，人工心肺開始時，大動脈肺動脈瘻により循環の維持が困難であった．術後PCPSによる循環補助を要したが2日目に離脱し49日目に退院した．弓部大動脈瘤に伴う大動脈肺動脈瘻は稀な疾患であるが，破裂死のみならずシャント血流過多により致命的な右心不全をもきたし，救命のためには早期の手術が必要である．

DOI： 10.3919/jjsa.73.3086

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objectives Postoperative disorders of the central nervous system remain a major problem in thoracic aortic surgery. Both retrograde cerebral perfusion and selective antegrade cerebral perfusion have become established techniques for cerebral circulatory management. In this study, we compared neurologic outcomes and mortality between retrograde cerebral perfusion and antegrade selective cerebral perfusion in patients with acute type A aortic dissection who underwent emergency ascending aorta replacement. Methods Between January 2003 and April 2011, a total of 203 patients with acute type A aortic dissection underwent emergency ascending aorta replacement in our hospital. We performed retrograde cerebral perfusion in 109 patients before 2006, and then mainly performed antegrade selective cerebral perfusion in 94 patients from 2006 onward. Results Cardiopulmonary bypass time and systemic circulatory arrest time were significantly longer in the antegrade selective cerebral perfusion group (p = 0.04, p\\0.001, respectively). The incidences of transient brain dysfunction and permanent brain dysfunction after surgery did not differ significantly between the groups. There were also no differences between the groups in other intraoperative variables, such as aortic cross-clamp time and the lowest rectal temperature, or in operative outcomes, including postoperative intensive-care-unit stay, mean peak amylase, and lipase levels until postoperative day 7, and 30-day mortality. Conclusion Both retrograde cerebral perfusion and antegrade selective cerebral perfusion were associated with acceptable levels of postoperative neurologic deficits, mortality, and morbidity. Either of these techniques for brain protection can be used selectively, based on a comprehensive assessment of general condition, in patients undergoing surgery for acute type A aortic dissection. © The Japanese Association for Thoracic Surgery 2012.

DOI： 10.1007/s11748-012-0142-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

An infected thoracoabdominal aneurysm is a rare, life-threatening condition with high mortality. We performed an in situ graft replacement and applied a rectus abdominis muscle flap transfer technique in a case of infected thoracoabdominal aortic aneurysm after distal gastrectomy. A rectus abdominis muscle flap transfer might be a good alternative when the omental flap technique is not feasible. © 2011 The Japanese Association for Thoracic Surgery.

DOI： 10.1007/s11748-010-0718-4

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記述言語：英語  

DOI： 10.1111/j.1540-8191.2010.01103.x

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記述言語：日本語   出版者・発行元：南江堂  

PubMed

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2010332097

記述言語：日本語   出版者・発行元：南江堂  

PubMed

CiNii Books

researchmap

その他リンク： http://search.jamas.or.jp/link/ui/2009346693

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：The Japanese Society for Cardiovascular Surgery  

症例は74歳,女性,主訴は労作時息切れ.心臓超音波検査では左室壁運動は良好であり(LVELF70.2%),左房左室の拡大を認めた(LAD53.4mm,LVDd58.5mm).僧帽弁は後尖の肥厚,可動性の低下を認め,弁輪にエコー輝度の増強する部分を認めた.カラードップラーでは,左房後尖側に向かう逆流jetを認めたが,前尖の逸脱は認めなかった.高度僧帽弁閉鎖不全症の診断で手術施行した.僧帽弁を観察すると限局した後尖弁輪の石灰化によって後尖P2が短縮しており,この部位が逆流の原因と考えられた.弁尖矩型切除,弁輪縫縮による僧帽弁形成術を施行した.術後経過は良好であり,術後の心臓超音波検査で僧帽弁閉鎖不全はtrivialまで改善していた.弁輪石灰化を伴う僧帽弁閉鎖不全症に対しては,形成術は不向きとされていたが,本症例のように石灰化が限局している症例に対しては弁尖切除,弁輪縫縮によって形成術は可能であると考えられた.

DOI： 10.4326/jjcvs.36.333

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