Aortic Valve Replacement Following Infectious Endocarditis Requiring Re-Operation Three Times
スポンサーリンク
概要
- 論文の詳細を見る
A 47-year-old man with active aortic valve endocarditis underwent direct closure of a paraannular abscess and valve replacement. Methicillin-resistant Staphylococcus aureus was isolated from his blood culture preoperatively. Because of a postoperative paravalvular leak (PVL) and an echo-free space suggesting a residual cavity, he was reoperated for patch closure of the aneurysm and prosthetic valve replacement. However, the PVL and paraannular cavity were still observed after the 2nd surgery. At the 3rd operation, prosthetic valve detachment along one fourth of its circumference was confirmed, and the cavity was fully opened. A patch was used to cover the pseudoaneurysm and was placed under the orifice of the left coronary artery. This patch repair of the cavity was accomplished, followed by prosthetic valve replacement in situ. Trivial PVL was identified after the operation, and a diagnosis of intravascular mechanical hemolysis was made. Clinical examination revealed partial detachment of the prosthetic valve resulting in a significant PVL and paraannular pseudoaneurysm. Because of unremitting hemolysis and the increased PVL, the patient underwent a 4th repair. Inspection showed that the prosthetic valve was partially detached and the defect was opened at the upper edge. The orifice of the aneurysmal was covered, and valve replacement was performed in the supraannular position using 3 U-stays, which were passed through both the aortic wall and the patch, followed by ascending aortic graft replacement. In the case of aortic valve endocarditis with paraannular involvement, radical debridement and complete reconstruction of the left ventriculoaortic discontinuity without tension are required.
- 特定非営利活動法人 日本心臓血管外科学会の論文
特定非営利活動法人 日本心臓血管外科学会 | 論文
- 慢性静脈不全症に対する深部静脈逆流遮断手術 弁形成術と弁置換術
- 高令者(70才以上)の腹部大動脈外科の検討
- 大腿吻合部動脈瘤の発生原因の検討
- High riskの潜在性凝固異常と腹部大動脈瘤手術
- Aorto-femoro-poplitealの広汎閉塞に対する2期的再建法の工夫