Severe Hemolysis after Mitral Valve Plasty: A Case Report of Reoperation with Mitral Valve Replacement.

症例は78歳女性.6年前に僧帽弁閉鎖不全症に対し,他院にてDuranリング使用で弁形成術を受けた.2年前から労作時息切れが生じしだいに増悪した.僧帽弁閉鎖不全は中等度であったが,著明な貧血が進行し,血清ハプトグロビンの著明な減少とLDH上昇により,溶血性貧血と診断した.溶血は進行性でLDH2,000以上となり貧血と相まって臨床症状も悪化した.逆流する血流がリングやプレジェットなどの人工物に当たり溶血していると判断し,保存的に改善は不可能と考え再手術を行った.術中所見では,術前診断のとおりでリングの一部は組織から遊離し,内皮で覆われていなかった.25mmのCarpentier Edwards牛心嚢膜生体弁による弁置換術を行い,経過良好で退院し,溶血は消失した.僧帽弁閉鎖不全症に対する弁形成術後の再手術には,原疾患進行による閉鎖不全再発,高度溶血などの理由が報告されている.若干の文献的考察を加えて報告する.

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