縦隔膿瘍の既往がある大動脈弁閉鎖不全症に対して右小開胸 MICS-AVR を施行した1例
症例は67歳女性，15年前に骨髄異形成症候群（myelodysplastic syndromes : MDS), Tolosa-Hunt症候群にてステロイド内服中に縦隔膿瘍を発症し左開胸ドレナージを施行した．術後創部は潰瘍形成し壊死性膿皮症と診断された．ヨウ化カリウム投与とステロイドパルスを施行し約3カ月後，瘢痕を残し上皮化した．2年前より心不全症状を認め，重症大動脈弁閉鎖不全症と診断された．手術適応と考えられたが，感染，皮膚症状を含めた合併症のリスクが高いと判断し経過観察されていた．しかし心不全症状が悪化し右小開胸によるMICS-AVRを施行した．術後経過は良好で術当日抜管し，合併症なく術後...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 50; no. 6; pp. 383 - 386 |
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| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本心臓血管外科学会
15.11.2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.50.383 |
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| Abstract | 症例は67歳女性，15年前に骨髄異形成症候群（myelodysplastic syndromes : MDS), Tolosa-Hunt症候群にてステロイド内服中に縦隔膿瘍を発症し左開胸ドレナージを施行した．術後創部は潰瘍形成し壊死性膿皮症と診断された．ヨウ化カリウム投与とステロイドパルスを施行し約3カ月後，瘢痕を残し上皮化した．2年前より心不全症状を認め，重症大動脈弁閉鎖不全症と診断された．手術適応と考えられたが，感染，皮膚症状を含めた合併症のリスクが高いと判断し経過観察されていた．しかし心不全症状が悪化し右小開胸によるMICS-AVRを施行した．術後経過は良好で術当日抜管し，合併症なく術後12日目に自宅退院した．縦隔炎，創部合併症のリスクが高い症例に対して右小開胸によるアプローチは有用であると考えられた． |
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| AbstractList | 症例は67歳女性，15年前に骨髄異形成症候群（myelodysplastic syndromes : MDS), Tolosa-Hunt症候群にてステロイド内服中に縦隔膿瘍を発症し左開胸ドレナージを施行した．術後創部は潰瘍形成し壊死性膿皮症と診断された．ヨウ化カリウム投与とステロイドパルスを施行し約3カ月後，瘢痕を残し上皮化した．2年前より心不全症状を認め，重症大動脈弁閉鎖不全症と診断された．手術適応と考えられたが，感染，皮膚症状を含めた合併症のリスクが高いと判断し経過観察されていた．しかし心不全症状が悪化し右小開胸によるMICS-AVRを施行した．術後経過は良好で術当日抜管し，合併症なく術後12日目に自宅退院した．縦隔炎，創部合併症のリスクが高い症例に対して右小開胸によるアプローチは有用であると考えられた． |
| Author | 後竹, 康子 高橋, 宏明 杉本, 貴樹 殿城, 秀斗 |
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| Copyright | 2021 特定非営利活動法人 日本心臓血管外科学会 |
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| References | 2) Schroeyers P, Vanermen H, Geest RD et al. Minimally invasive video-assisted mitral valve surgery : our lessons after a 4-year experience. Ann Thorac Surg 2001 ; 72 : S1050-4. 16) Yamazaki M, Kin H, Kitamoto S et al. Efficacy of the stonehenge technique for minimally invasive aortic valve replacement via right infraaxillary thoracotomy. Ann Thorac Cardiovasc Surg 2017 ; 23 : 45-8. 8) Chien S, Clark C, Maheshwari S et al. Benefits of rapid deployment aortic valve replacement with a mini upper sternotomy. J. Cardiothorac Surg 2020 ; 15 : 226. 1) Cosgrove DM, Sabik JF. Minimally invasive approach for aortic valve operations. Ann Thorac Surg 1996 ; 62 : 596-7. 13) Yoshida E, Chiyomaru Y, Fukuda H et al. A case of pyoderma gangrenosum with aspetic cervical and mediastinal abscesses in a patient with MDS and Tolosa-Hunt syndrome. Skin Res 2006 ; 5 : 133-8. 9) Glauber M, Moten SC, Quaini E et al. International expert consensus on sutureless and rapid deployment valves in aortic valve replacement using minimally invasive approaches. Innovatinos 2016 ; 11 : 165-73. 10) Elisa M, Simone C, Gianluca C et al. Full sternotomy, hemisternotomy, and minithoracotomy for aortic valve surgery : is there a difference?. Ann Thorac Surg 2018 ; 106 : 1782-8. 12) Nishi H, Miyata H, Motomura N et al. Propensity-matched analysis of minimally invasive mitral valve repair using a nationwide surgical database. Surg Today 2015 ; 45 : 1144-52. 11) Bowdish ME, Hui DS, Cleveland JD et al. A comparison of aortic valve replacement via an anterior right minithoracotomy with standard sternotomy : a propensity score analysis of 492 patients. Eur J Cardiothorac Surg 2016 ; 49 : 456-63. 3) Walther T, Mohr FW, Falk V et al. Minimally invasive mitral valve surgery. J Cardiovasc Surg 2004 ; 45 : 487-95. 4) Omoto T, Yozu R, Shin H et al. Minimally invasive cardiac surgery in patients older than 65 years. Jpn J Artif Organ 1998 ; 27 : 56-8. 17) Sawaya FJ. Deutsch MA, Seiffert M et al. Safety and efficacy of transcatheter aortic valve replacement in the treatment of pure aortic regurgitation in native valves and failing surgical bioprostheses : results from an international registry study. JACC Cardiovasc Interv 2017 ; 10 : 1048-56. 7) Glauber M. Minimally invasive aortic valve replacement. The 44th Annual Meeting of the Society of Thoracic Surgeons. 2008. 14) Stolinski J, Fijorek K, Plicner D et al. Perioperative outcomes of minimally invasive aortic valve replacement through right anterior minithoracotomy. Thorac Cardiovasc Surg 2016 ; 64 : 392-9. 6) Christiansen S, Stypmann J, Tjan TD et al. Minimally invasive versus conventional aortic valve replacement perioperative course and mid-term result. Eur J Cardio-thorac Surg 1999 ; 16 : 647-52. 18) Franzone A, Piccolo R, Siontis GCM et al. Transcatheter aortic valve replacement for the treatment of pure native aortic valve regurgitation : a systematic review. JACC Cardiovasc Interv 2016 ; 9 : 2308-17. 5) Ghanta RK, Lapar DJ, Kern JA et al. Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement : a real-world multi-institutional analysis. J Thorac Cardiac Surg 2015 ; 149 : 1060-5. 15) Totsugawa T, Hiraoka A, Tamura K et al. Clamp ablation of pulmonary veins during minimally invasive aortic valve replacement. Ann Thorac Surg 2017 ; 104 : e471-3. |
| References_xml | – reference: 1) Cosgrove DM, Sabik JF. Minimally invasive approach for aortic valve operations. Ann Thorac Surg 1996 ; 62 : 596-7. – reference: 12) Nishi H, Miyata H, Motomura N et al. Propensity-matched analysis of minimally invasive mitral valve repair using a nationwide surgical database. Surg Today 2015 ; 45 : 1144-52. – reference: 4) Omoto T, Yozu R, Shin H et al. Minimally invasive cardiac surgery in patients older than 65 years. Jpn J Artif Organ 1998 ; 27 : 56-8. – reference: 3) Walther T, Mohr FW, Falk V et al. Minimally invasive mitral valve surgery. J Cardiovasc Surg 2004 ; 45 : 487-95. – reference: 11) Bowdish ME, Hui DS, Cleveland JD et al. A comparison of aortic valve replacement via an anterior right minithoracotomy with standard sternotomy : a propensity score analysis of 492 patients. Eur J Cardiothorac Surg 2016 ; 49 : 456-63. – reference: 2) Schroeyers P, Vanermen H, Geest RD et al. Minimally invasive video-assisted mitral valve surgery : our lessons after a 4-year experience. Ann Thorac Surg 2001 ; 72 : S1050-4. – reference: 9) Glauber M, Moten SC, Quaini E et al. International expert consensus on sutureless and rapid deployment valves in aortic valve replacement using minimally invasive approaches. Innovatinos 2016 ; 11 : 165-73. – reference: 7) Glauber M. Minimally invasive aortic valve replacement. The 44th Annual Meeting of the Society of Thoracic Surgeons. 2008. – reference: 13) Yoshida E, Chiyomaru Y, Fukuda H et al. A case of pyoderma gangrenosum with aspetic cervical and mediastinal abscesses in a patient with MDS and Tolosa-Hunt syndrome. Skin Res 2006 ; 5 : 133-8. – reference: 18) Franzone A, Piccolo R, Siontis GCM et al. Transcatheter aortic valve replacement for the treatment of pure native aortic valve regurgitation : a systematic review. JACC Cardiovasc Interv 2016 ; 9 : 2308-17. – reference: 6) Christiansen S, Stypmann J, Tjan TD et al. Minimally invasive versus conventional aortic valve replacement perioperative course and mid-term result. Eur J Cardio-thorac Surg 1999 ; 16 : 647-52. – reference: 17) Sawaya FJ. Deutsch MA, Seiffert M et al. Safety and efficacy of transcatheter aortic valve replacement in the treatment of pure aortic regurgitation in native valves and failing surgical bioprostheses : results from an international registry study. JACC Cardiovasc Interv 2017 ; 10 : 1048-56. – reference: 10) Elisa M, Simone C, Gianluca C et al. Full sternotomy, hemisternotomy, and minithoracotomy for aortic valve surgery : is there a difference?. Ann Thorac Surg 2018 ; 106 : 1782-8. – reference: 14) Stolinski J, Fijorek K, Plicner D et al. Perioperative outcomes of minimally invasive aortic valve replacement through right anterior minithoracotomy. Thorac Cardiovasc Surg 2016 ; 64 : 392-9. – reference: 15) Totsugawa T, Hiraoka A, Tamura K et al. Clamp ablation of pulmonary veins during minimally invasive aortic valve replacement. Ann Thorac Surg 2017 ; 104 : e471-3. – reference: 16) Yamazaki M, Kin H, Kitamoto S et al. Efficacy of the stonehenge technique for minimally invasive aortic valve replacement via right infraaxillary thoracotomy. Ann Thorac Cardiovasc Surg 2017 ; 23 : 45-8. – reference: 8) Chien S, Clark C, Maheshwari S et al. Benefits of rapid deployment aortic valve replacement with a mini upper sternotomy. J. Cardiothorac Surg 2020 ; 15 : 226. – reference: 5) Ghanta RK, Lapar DJ, Kern JA et al. Minimally invasive aortic valve replacement provides equivalent outcomes at reduced cost compared with conventional aortic valve replacement : a real-world multi-institutional analysis. J Thorac Cardiac Surg 2015 ; 149 : 1060-5. |
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| SubjectTerms | MICS 右小開胸 大動脈弁置換術 縦隔炎 |
| Title | 縦隔膿瘍の既往がある大動脈弁閉鎖不全症に対して右小開胸 MICS-AVR を施行した1例 |
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