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This study investigated the feasibility of mitral valve (MV) repair in patients with active or healed infective endocarditis (IE) with mitral regurgitation and evaluated effects on left ventricular (LV) function and structure.Subjects comprised 19 patients who underwent MV operations for IE between December 2004 and September 2007. MV repair was performed for acute IE in 10 of 15 patients (67%) and for healed IE in 4 of 4 patients (100%).No early or late postoperative deaths were encountered. One patient underwent redo MV repair owing to severe mitral regurgitation 1 month postoperatively. Postoperative echocardiography after MV repair demonstrated less than trivial (acute IE in seven, healed IE in three) or mild (acute IE in three, healed IE in one) mitral regurgitation. In patients with MV replacement, the postoperative left atrial dimension (LAD) was decreased (51.5 +/- 39.2 vs. 39.2 +/- 1.9 mm, P = 0.007); however LV end-diastolic dimension (LVDD) and LV end-systolic dimension were unchanged. In patients with MV repair, LVDD (57.5 +/- 6.5 vs. 46.0 +/- 5.6 mm, P0.001), LV end-systolic dimension (36.1 +/- 5.2 vs. 32.4 +/- 6.2 mm, P = 0.04), LAD (43.1 +/- 8.1 vs. 33.6 +/- 7.7 mm, P = 0.003) were reduced. Postoperative ejection fraction (55.3 +/- 13.5% vs. 41.8% +/- 10.0%, P = 0.03) and fraction shortening (30.1% +/- 9.2% vs. 20.7% +/- 5.5%, P = 0.03) were better in patients with MV repair than those with MV replacement.MV repair is feasible in patients with both active and healed IE. MV repair preserves better LV function and structure postoperatively.

54歳，女性．3カ月前からの発熱を主訴に来院．心エコーにて僧帽弁前尖（A3）から後尖（P3）に付着する疣贅と重度の僧帽弁逆流を認めた．また，冠動脈造影および造影 CT にて右冠動脈から冠状静脈洞への動静脈瘻を認めた．血液培養にて Strep. viridans を検出し，活動期感染性心内膜炎を合併した冠動脈瘻の診断にて準緊急手術施行した．疣贅は A3 から P3 に及び，感染巣を可及的に除去し，欠損部をグルタールアルデヒド処理自己心膜にて補填した．また人工腱索，人工弁輪を用いて形成術を施行した．右冠動脈の冠状静脈洞流入部は術中同定可能であり，心外膜側より結紮処理し，末梢へバイパス術を施行した．術後経過は順調であり軽快退院となった．今後，冠動脈瘻の再発および拡大，心筋梗塞等の遠隔期合併症に対し経過観察が必要である．