Key result
Mitral valve replacement and coronary artery bypass grafting were successfully performed in a 67-year-old female with caseous calcification of the mitral annulus, mitral regurgitation, and ischemic heart disease.
Case Report (n=1)
No
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Mitral valve replacement and CABG can be successfully performed in patients with severe ischemic mitral regurgitation complicated by caseous calcification of the mitral annulus, though careful handling of the fragile calcified mass and annular reconstruction may be required.
僧帽弁輪乾酪性石灰化（caseous calcification of mitral annulus : CCMA）は僧帽弁の腫瘤性変化を特徴とする稀な疾患であるが，血行動態に影響を与えることが少ないことからその手術報告はきわめて少ない．今回，われわれは虚血性心臓病（IHD）を基礎に僧帽弁閉鎖不全症（MR）を合併し，心不全が急性増悪したCCMA症例に対し僧帽弁置換術（MVR）および冠動脈バイパス手術（CABG）を行った．症例は67歳女性で急激に増悪した心不全の精査で僧帽弁後尖の腫瘤性病変を伴った高度MRと左冠動脈主幹部を含む3枝病変を認めた．僧帽弁逆流の制御と冠血行再建を目的に生体弁によるMVRおよびCABGを施行した．僧帽弁後尖の腫瘤性病変は弁輪に達しており，弁尖切除後に自己心膜による弁輪形成を必要とした．病理診断で僧帽弁後尖の腫瘤は乾酪性石灰化病変であった．術中所見を中心に報告する．
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Ikushima et al. (2015) conducted a case report in Caseous calcification of mitral annulus with mitral regurgitation and ischemic heart disease (n=1). Mitral valve replacement and coronary artery bypass grafting was evaluated. Mitral valve replacement and coronary artery bypass grafting were successfully performed in a 67-year-old female with caseous calcification of the mitral annulus, mitral regurgitation, and ischemic heart disease.
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