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(6): 292-298 (2015)
doi:10.9794/jspccs.31.292

ReviewReview

体外循環を使用した胎児心臓手術開発の現状と可能性Developments in the Field of Fetal Surgery Using Extracorporeal Support: Current Standpoint

岡山大学大学院医歯薬学総合研究科心臓血管外科学教室Department of Cardiovascular Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University ◇ 〒700-8558 岡山県岡山市北区鹿田町二丁目5番1号Shikata-cho 2-5-1, Kita-ku, Okayama-shi, Okayama 700-8558, Japan

受付日:2015年3月13日Received: March 13, 2015
受理日:2015年9月8日Accepted: September 8, 2015
発行日:2015年11月1日Published: November 1, 2015
HTMLPDFEPUB3

考えられうる胎児手術の中で,体外循環を用いた胎児手術は最も実現困難で挑戦的な治療法である.現在ではカテーテルによる,先天性心疾患を有する胎児への治療が臨床で実用化され,一部の疾患に対しては,胎児期への治療介入がその後の患児の心臓の発達をより正常な方向へ誘導する可能性が示唆されている.しかしながら,カテーテルで治療介入できる範囲は限定的で,TAPVC,HLHS,PA/IVS,Ebstein奇形等では,外科的手技により,より高度な胎児期治療介入が可能であれば,その後の心臓の発達を改善する可能性があると考えられる.1985年にRichterらが初めて,胎児に体外循環を導入する動物実験を報告し,その後様々な発展を経てきたが,約30年を経過した今でも,未だにヒトに体外循環を用いた胎児手術を行い,成功した例はない.体外循環を用いた胎児心臓手術開発の現況とその可能性について報告する.

The use of cardiopulmonary bypass during surgery is the most challenging procedure in all the possible fetal cardiac interventions. Catheter-based fetal cardiac interventions have recently been developed and applied in the clinical setting for a particular category of congenital heart diseases. The intention was to improve long-term results by allowing the heart to grow normally before birth. However, the procedures that can be performed using catheter intervention are very limited, the primary examples of which are atrial septostomy, aortic valvotomy, and pulmonary valvotomy. There is still a group of congenital heart diseases, such as total anomalous pulmonary venous connection, hypoplastic left heart syndrome, pulmonary atresia with intact ventricular septum, and Ebstein's anomaly, for which long-term results could be improved or Fontan circulation could be avoided using fetal surgical cardiac intervention but may not be achieved using catheter intervention. In 1985, Richter et al first reported an animal study on fetal cardiopulmonary bypass. Since this report, which was over 30 years ago, several developments in this field have been achieved; however, there are no case reports on successful fetal cardiopulmonary bypass in humans. The aim of this study was to determine the current status of developments in fetal surgical intervention using cardiopulmonary bypass.

Key words: fetus; basic sciences; cardiac surgery; small axial ventricular assist device

This page was created on 2015-10-30T13:21:01.881+09:00
This page was last modified on 2015-11-27T10:15:41.606+09:00


このサイトは(株)国際文献社によって運用されています。