Key result
Sandwich method achieves successful VSD closure in extensive infective endocarditis without residual shunt.
Why the study?
Infective endocarditis with extensive ventricular septal destruction requires effective septal reconstruction methods, but optimal surgical approaches are not well established.
Case Report (n=1)
No
The sandwich method using bovine pericardial patches is a useful technique for septal reconstruction in patients with infective endocarditis complicated by extensive ventricular septal destruction.
Sandwich repair succeeded in extensive IE-related VSD; leaves open generalizability pending larger series.
症例は74歳男性で，診断は大動脈弁位と三尖弁位の感染性心内膜炎，心室中隔欠損症，完全房室ブロックである．発熱と頸部痛を主訴に前医に入院し，経過中に完全房室ブロックを発症した．心エコー検査で重症大動脈弁逆流，大動脈弁の疣贅と心室中隔欠損症を指摘されて当院へ搬送され，同日緊急手術が行われた．大動脈弁尖は石灰化して肥厚しており，高度な弁尖破壊を伴っていた．疣贅は一部右冠尖と無冠尖の弁下まで及んでいた．疣贅は心房中隔から心室中隔欠損孔，三尖弁まで伸展していた．ウシ心膜パッチ2枚を用いたsandwich法による中隔再建後に大動脈弁置換術，三尖弁置換術を行った．術後は6週間の抗生剤加療が行われ，ペースメーカー植え込み術後に自宅退院した．心エコー検査で残存シャントは見られなかった．本症例の経験から，広範に心室中隔が破壊された感染性心内膜炎に対し，sandwich法は有用な中隔再建法の1つであると考えられた．
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Sasaki et al. (2024) conducted a case report in Infective endocarditis with ventricular septal defect and complete atrioventricular block (n=1). Ventricular septal defect closure with the sandwich method, aortic valve replacement, and tricuspid valve replacement was evaluated on Clinical outcome (survival, residual shunt). Ventricular septal defect closure using the sandwich method was successfully performed in a patient with extensive infective endocarditis, resulting in no residual shunt and discharge home.
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