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約3年前に食道癌・胃癌に対し食道・胃全摘術左半結腸による胸骨前皮下食道再建術を施行された症例が僧帽弁に逆流を認める感染性心内膜炎と診断された右第四肋間開胸で僧帽弁置換術を施行し良好な結果を得た症例は77歳の男性であった発熱肉眼的血尿食欲不振を主訴として来院し入院した心エコーで IV度の僧帽弁逆流と診断され血液培養で Streptococcus species が検出された NYHA はIV度であったが抗生剤で治療し約1カ月後に僧帽弁置換術を施行した胸骨正中切開は再建食道のため不可能で右前側方開胸で手術を施行した人工心肺の送血は右大腿動脈とし脱血としては右大腿静脈から下大静脈まで脱血管を挿入し右内頸静脈を皮膚切開で露出して上大静脈まで脱血管を挿入した25℃まで全身を冷却し心室細動下に右側左房切開で僧帽弁を SJM 29mm人工弁で置換した術中胸腔内には二酸化炭素を充満させた加温後直流除細動で心拍再開し大動脈基部に心筋保護液注入管を挿入し空気抜きを施行しながら人工心肺から離脱した術後覚醒時全身痙攣が見られたが一度で消失し以後良好な経過であった A case of infectious endocarditis was surgically treated by mitral valve replacement. The patient had previously undergone presternal subcutaneous colonic interposition as reconstruction surgery due to esophageal and gastric cancer. This artificial esophagus prevented the central sternotomy that is necessary for cardiac surgery. In cases where sternotomy is difficult, anterolateral right intercostal thoracotomy is useful. Arterial cannulation was performed via the femoral artery ; cannulations for venous drainage were performed in the femoral vein for the inferior vena cava and in the right jugular vein for the superior vena cava in order to establish cardiopulmonary bypass circulation. Under the condition of ventricular fibrillation and a body temperature of 25℃, the mitral valve that had been destroyed by infection was resected by exposure of the left atrium on its right side. An artificial Saint Jude Medical mechanical valve, 29mm in diameter, was implanted. The thorax was insufflated with carbon dioxide gas to prevent air embolization. An aortic vent tube was used for air drainage from the cardiac output. Although a seizure occurred once after the operation, the post-operative course was very stable ; currently, the patient (NYHA I) is in very good condition with no recurrence of the cancer

japanese journal of cardiovascular surgery/nihon shinzō kekkan geka gakkai zasshi

Anterolateral Right Thoracotomy for Mitral Valve Replacement for Treating Infectious Endocarditis in a Case with Esophagus Reconstructed by Presternal Colonic Interposition for Previous Esophagogastrectomy