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

Online ISSN: 2187-2988 Print ISSN: 0911-1794
特定非営利活動法人日本小児循環器学会 Japanese Society of Pediatric Cardiology and Cardiac Surgery
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Pediatric Cardiology and Cardiac Surgery 31(1-2): 25-29 (2015)
doi:10.9794/jspccs.31.25

教育セミナー教育セミナー

手術術式緊急・準緊急姑息術のPointPalliation of Congenital Heart Disease in the Current Era

兵庫県立こども病院心臓血管外科Department of Cardiovascular Surgery, Kobe Children’s Hospital ◇ 〒654-0081 兵庫県神戸市須磨区高倉台1丁目1番1号1-1-1 Takakuradai, Suma-ku, Kobe-shi, Hyogo 654-0081, Japan

発行日:2015年3月1日Published: March 1, 2015
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姑息手術の多くは,肺血流調整を目的に行われ,特に肺血管抵抗の高い新生児期に適応される.修復術が低年齢化し,早期の一期的修復術が進んだ現在でも,体・肺動脈短絡術,肺動脈絞扼術の適応が見直され,かつ多様化している.体外循環を用いた修復術や姑息術がより安全に行われるようになった一方で,新生児期の体外循環を回避し,周術期,遠隔成績のさらなる成績向上のため,両側肺動脈絞扼術のように復活した術式もある.肺血管抵抗が変動する周術期に,いかに適切な肺血流調整が行えるかが重要となる.肺動脈絞扼術においては,なるべく正中切開アプローチを選択し,術中心表面エコーを用いて,適切な肺動脈絞扼部位や絞扼度の決定を行う.体肺動脈短絡術の周術期管理では,複雑な病態把握が必要である.特に単心室の血行動態を理解し,動脈血酸素飽和度に加え,混合静脈血酸素飽和度や近赤外光法など,様々な方法で体・肺血流バランスをモニターすることが重要である.

In the modern era, advances in open-heart surgery as the first choice for treating many congenital cardiac defects have decreased markedly as indications for palliative procedures. However, palliative surgery is still needed for the selected patients. Furthermore, the indications for palliative procedures have expanded far beyond the original concept. The main goals of palliation are to alter the hemodynamic physiology, i.e., to control the pulmonary blood flow, particularly the normally high neonatal pulmonary vascular resistance. Implantation of a systemic-pulmonary artery shunt (SP shunt) and pulmonary artery banding (PAB) are the two primary methods of palliation. The physiology of circulation incorporating an SP shunt is complex, particularly lesions within a single ventricle. Consequently, the SP shunt is still associated with a significant incidence of adverse outcomes. A clear understanding of the anatomy and physiology is important. PAB also continues to occupy an important place in surgical treatment for very young infants for whom cardiopulmonary bypass is associated with a great risk. The role of PAB is to reduce pulmonary blood overflow to prevent or reverse cardiac failure and to provide long-term protection against irreversible pulmonary hypertension. Moreover, several cardiac defects can benefit from early PAB, especially when preparation and training of the left ventricle is necessary. Bilateral PAB is also an attractive and effective method for the control of pulmonary blood flow in ductal-dependent lesions.

Key words: neonate; palliation; systemic-pulmonary artery shunt; pulmonary artery banding; pulmonary vascular resistance

This page was created on 2015-03-09T17:05:49.953+09:00
This page was last modified on 2015-03-23T21:24:45.750+09:00


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