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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.

症例は6ヵ月間の発熱病歴を有し,小児期より心室中隔欠損症(VSD)と診断されていた44歳の男性である.平成16年7月,VSDに伴った感染性心内膜炎による大動脈弁閉鎖不全症と診断し,生体弁による弁置換術およびVSDのパッチ閉鎖術を施行した.しかし術後,炎症反応は陰転化せず,術後3ヵ月目に血中からCandida albicansが検出された.人工弁感染が疑われたため,術後3.5ヵ月でFree styleブタ大動脈弁により大動脈基部置換およびVSDの再閉鎖術を行った.その後,抗真菌剤の内服を継続して外来経過観察していたが,平成17年5月に再び発熱が出現,CTで左総腸骨動脈瘤を認め,Candida albicansによるmycotic aneurysmを疑い手術を施行した.活動型感染性心内膜炎では抗生剤投与が長期にわたると真菌症を併発することを認識すべきである.真菌性感染性心内膜炎は感染制御の困難性から長期予後は不良とされ,術後の経過観察は長期間,厳重に行うことが必要である.