Key result
A modified Bentall procedure combined with mitral valve replacement using continuous warm blood cardioplegia was successfully performed, yielding good postoperative cardiac function and a low peak CK-MB of 231 U/L.
Case Report (n=1)
A modified Bentall procedure combined with MVR using continuous warm blood cardioplegia provided effective myocardial protection in a patient with Marfan's syndrome despite a prolonged cross-clamp time.
CWBC supported good early cardiac recovery despite 235-min cross-clamp; leaves open comparative efficacy versus intermittent cardioplegia in Marfan aortopathy.
Marfan症候群に伴うannulo-aortic ectasia (AAE) 兼僧帽弁閉鎖不全症の1例に対して術中心筋保護法としてcontinuous warm blood cardioplegia (CWBC) を用いてmodified Bentall兼僧帽弁置換術 (MVR) を行い良好な結果を得た。症例は42歳, 女性。精査の結果, 前記診断に加えて心筋障害及び左室機能低下を認めた。手術は先ず機械弁にてMVRを行い, 次いで機械弁付きcornposite graftにて大動脈基部置換 (modified Bentall手術) を行った。この際冠動脈の再建は短い10mm径人口血管をinterposeするInterposition graft法にて行い, 中膜壊死による組織脆弱性への対策として弁輪部へのTeflon felt stripの使用などの手技的工夫を行った。術中心筋保護法は我々の数年来の経験にて優れた心筋保護効果を認めているCWBCを用いた。複雑な手術手技のため大動脈遮断時間は235分と長時間に及んだが, 術後急性期の心機能は良好で, CK・MB最高値は231U/Lと低値を示し満足すべき結果を得た。本症例の経験から心筋保護法としてCWBCを用い, 冠動脈再建法としてInterpositiong raft法を用いたmodified Bentall兼MVRは推奨し得る方法と考えられる。
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NAGAOKA et al. (1997) conducted a case report in Marfan's syndrome with annulo-aortic ectasia and mitral regurgitation (n=1). Modified Bentall procedure combined with mitral valve replacement using continuous warm blood cardioplegia was evaluated on Postoperative acute cardiac function and peak CK-MB. A modified Bentall procedure combined with mitral valve replacement using continuous warm blood cardioplegia was successfully performed, yielding good postoperative cardiac function and a low peak CK-MB of 231 U/L.
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