<Case Report>A New Method for Coronary Artery Reconstruction in Patients with Recurrent Aortic Prosthetic Valve Endocarditis and an Inaccessible Coronary Arterial System

Abstract

A new approach to the problem of recurrent infection of an aortic valve prosthesis in a patient with an inaccessible coronary arterial system is presented. The coronary arteries were reconstructed by anastomosing a looped ringed-PTFE graft to the left and right coronary ostia within the aorta, and the graft was withdrawn from the aorta just above th e ostia. Then the top of the looped graft was anastmosed to the aorta above a translocated aortic prosthesis. This procedure is most likely to be useful in the treatment of recurrent aortic prosthetic valv e endocarditis which has dense pericardial adhesion secondary to multiple cardiac operations. Aortic prosthetic valve endocarditis frequently is associated with a paravalvular ring abscess which may destroy the normal annulus. In these cases, translocating the aortic valve to the ascending aorta, and placing saphenous vein bypass grafts to the right and th e left anterior descending coronary arter y may be required. However, the coronary arteries may not be accesible following multipie operations. The following case illustrates a new solution to the problem how to translocated the aortic valve and reconstruct the coronary arteries in a patient with an infected aortic root and inaccessible coronary arteries.

4回の関心術による癒着のため冠動脈の走行が判別不能であった大動脈弁輪部膿瘍を伴なった感染性心内膜炎症例に対し, 冠動脈再建に新しい方法を用いたトランスロケーション法を行った. 8 mmφ のリング付き PTFE 人工血管の両端を大動脈の内腔で左右冠動脈孔に縫着し, その直ぐ末梢側で一旦大動脈外にグラフトを出しそのループの頂点部を転位縫着した人工弁の末梢側で大動脈(弁付き人工血管の場合は人工血管)と側側に吻合する方法を行った. 術後経過は順調で, 狭心症, 不整脈は発生していない.