1 Royal Brompton Hospital ◇ Sydney Street, London SW3 6NP, United Kingdom
2 奈良県立医科大学附属病院先天性心疾患センターCongenital Heart Disease Center, Nara Medical University Hospital ◇ 〒634-8522 奈良県橿原市四条町840番地840 Shijo-cho, Kashihara-shi, Nara 634-8522, Japan
英国の肺動脈弁置換（PVR）の実状を，1）National database（2000年以降），2）一つの主要施設（2004年以降），3）一人のConsultant Surgeon，の3段階の観点から俯瞰する．
1）総計7,028例の成人先天性心疾患手術例のうち25%がPVR（1年生存率98%）で，過去10年間に著増した．
2）PVRを393例に施行，平均32±12歳．ファロー四徴修復術後（242例）および肺動脈狭窄の解除手術後（78例）が主要な病変であった（手術死亡率1.6%）．PVRに使用した弁は，生体弁227例，homograftが133例，生体弁付き導管33例であった．
3）117例の成人期PVR例のうち109例が生体弁．先行修復術において肺動脈弁輪が温存されていた31例では弁輪切開後症例に比べて術前心胸郭比は小さい傾向があった（p=0.009）．同時術式として，三尖弁手技29例，外科的抗不整脈処置13例，左・右肺動脈起始部拡大を11例に施行した．88例では心拍動下にPVRを行った．8例では大腿動脈カニュレーションを行った．2例が早期死亡（高度右心不全・心室性不整脈）．遠隔死亡はなく，再手術を2例に要した．側弯症を30例に認めた．
以上より，英国におけるPVRの現況を，全体像とともに，一部において具体的な臨床要因まで提示した．
To review the recent circumstances for surgical pulmonary valve replacement (PVR) in the United Kingdom, we summarized the clinical data from three different levels: 1) statistics in the National Database, 2) experience at a major adult congenital heart center, and 3) experience of a surgeon at the institution.
1) The number of patients who underwent PVR markedly increased during the last decade, and the sum total was 25% of the 7,028 surgical cases with adult congenital heart disease that were registered in the database.
2) The institution had 393 patients of PVR, including 242 with repaired tetralogy of Fallot and 78 after pulmonary stenosis relief. For the valves, a bioprosthesis was used in 227 patients, a homograft was used in 133, and a conduit bearing a bioprosthesis in 33.
3) The surgeon preferred to use a bioprosthesis in 109 of his 117 patients. The pre-PVR cardiothoracic ratio was smaller in 31 patients in whom the pulmonary valvular hinge had been preserved (p=0.009) than in those who had a trans-annular incision. Concomitantly with PVR, a tricuspid valve procedure was performed in 29 patients, surgical anti-arrhythmic procedure in 13, and an enlargement of the proximal right/left pulmonary artery in 11. The PVR maneuver was performed with a beating heart in 88 patients. Femoral cannulation was required in 8. Two patients died early due to severe right heart failure or sudden ventricular arrhythmia. In the longer term follow-up, no further deaths were noted. Two patients required re-operation. A degree of scoliosis was observed in 30 patients.
This review illustrates the current status of PVR practice in the UK.
Key words: pulmonary valve replacement; adult congenital heart disease; tetralogy of Fallot; pulmonary regurgitation; right ventricular failure
© 2015 特定非営利活動法人日本小児循環器学会© 2015 Japanese Society of Pediatric Cardiology and Cardiac Surgery
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This page was last modified on 2015-08-14T10:21:42.433+09:00
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