心室中隔欠損閉鎖に用いるパッチ幅を基準化した完全型房室中隔欠損修復術

山内早苗; 川田博昭; 盤井成光; 上仲永純; 荒木幹太; 萱谷太; 稲村昇; 岸本英文

doi:10.9794/jspccs.31.119

心室中隔欠損閉鎖に用いるパッチ幅を基準化した完全型房室中隔欠損修復術Surgical Correction of Complete Atrioventricular Septal Defects with Standardized Sized Ventricular Septal Defect Patch Width

山内早苗¹，川田博昭¹，盤井成光¹，上仲永純¹，荒木幹太¹，萱谷太^1,2，稲村昇^1,2，岸本英文¹Sanae Yamauchi¹, Hiroaki Kawata¹, Shigemitsu Iwai¹, Hisazumi Uenaka¹, Kanta Araki¹, Futoshi Kayatani^1,2, Noboru Inamura^1,2, Hidefumi Kishimoto¹

¹ 大阪府立母子保健総合医療センター小児医療部門心臓血管外科Department of Cardiovascular Surgery, Chidren's Hospital, Osaka Medical Center and Research Institute for Maternal and Child Health ◇ 〒594-1101 大阪府和泉市室堂町840番地840 Murodo-cho, Izumi-shi, Osaka 594-1101, Japan

² 大阪府立母子保健総合医療センター小児医療部門小児循環器科Department of Pediatric Cardiology, Chidren's Hospital, Osaka Medical Center and Research Institute for Maternal and Child Health ◇ 〒594-1101 大阪府和泉市室堂町840番地840 Murodo-cho, Izumi-shi, Osaka 594-1101, Japan

受付日：2014年8月19日Received: August 19, 2014

受理日：2015年4月10日Accepted: April 10, 2015

発行日：2015年5月1日Published: May 1, 2015

背景：完全型房室中隔欠損（CAVSD）修復術後，再手術の最大のリスクファクターとなる左側房室弁逆流（LAVVR）を防ぐため，われわれは，心室中隔欠損（VSD）閉鎖のパッチ幅を造影検査の正常三尖弁輪径（31.1×BSA^0.56）＋4 mmとしている．今回その手術成績を検討した．

方法：1995年1月から2011年12月までに当院でCAVSD修復術を行った27例を対象とし，手術成績を後方視検討した．

結果：術後観察期間は最長18.5年（中央値8.2年）で，早期死亡は1例（肺梗塞），遠隔死亡は1例（特発性肺静脈狭窄）であった．心臓超音波検査による退院時のLAVVRはmild以下24例，moderate 2例で，左側房室弁狭窄を呈した症例はなかった．中期遠隔期のLAVVRは，mild以下23例，moderate 3例で，severe LAVVRとなった症例はなく，心機能も保たれた．房室弁逆流に対する再手術を1例に行ったが，弁置換を要した症例はなく，再手術回避率は5年，10年，15年96.2%であった．

結論：VSDパッチ幅を正常三尖弁輪径+4 mmに基準化したCAVSD修復術は中期遠隔期においても重度の弁逆流を呈さず，成績は良好であった．

Background: Left atrioventricular valve regurgitation (LAVVR) is the main indication for reoperation in patients after repair of complete atrioventricular septal defects (CAVSD). In order to prevent postoperative LAVVR, we use a ventricular septal defect (VSD) patch for CAVSD repair of width 31.1∗BSA^0.56 (i.e., equal to the normal tricuspid valve annular diameter)+4 mm.

Methods: We evaluated the surgical outcome in 27 patients with CAVSD who underwent surgical repair at our institution between January 1995 and December 2011.

Results: The maximum follow-up duration after surgical correction was 18.5 years (median, 8.2 years). One early death (due to pulmonary embolism) and one late death (due to idiopathic pulmonary vein stenosis) occurred after the surgery. At discharge, 24 patients had less than moderate LAVVR and 2 patients had moderate LAVVR. Left atrioventricular valve stenosis was not observed. At mid-term follow-up, 23 patients had less than moderate LAVVR and 3 patients had moderate LAVVR. There was no case of severe LAVVR, and cardiac function was preserved in all patients. Only 1 patient required reoperation for LAVVR although valve replacement was not necessary. Freedom from reoperation was 96.2% at 5, 10, and 15 years.

Conclusion: Standardizing the patch width (normal tricuspid valve annular size+4 mm) led to good intermediate to long-term results in patients with CAVSD.

Key words: complete atrioventricular septal defect; ventricular septal defect; atrioventricular valve regurgitation; reoperation

日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

原著Original

心室中隔欠損閉鎖に用いるパッチ幅を基準化した完全型房室中隔欠損修復術Surgical Correction of Complete Atrioventricular Septal Defects with Standardized Sized Ventricular Septal Defect Patch Width