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
Pediatric Cardiology and Cardiac Surgery 31(6): 301-308 (2015)


二心室修復における右室流出路の人工導管狭窄に対するステント留置Stenting for Right Ventricular Outflow Tract Conduits in the Biventricular Heart

1昭和大学横浜市北部病院循環器センターCardiovascular Center, Showa University Northern Yokohama Hospital ◇ 〒224-8503 神奈川県横浜市都筑区茅ケ崎中央35番1号Chigasaki-Chuo 35-1, Tsuzuki-ku, Yokohama-shi, Kanagawa 224-8503, Japan

2岡山大学病院小児循環器科Division of Pediatric Cardiology, Okayama University Hospital ◇ 〒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

3埼玉医科大学国際医療センター心臓病センター小児心臓科Department of Pediatric Cardiology, Heart Center, Saitama Medical University International Medical Center ◇ 〒350-1298 埼玉県日高市山根1397番地1Yamane 1397-1, Hidaka-shi, Saitama 350-1298, Japan

4公益財団法人日本心臓血圧研究振興会附属榊原記念病院小児循環器科Department of Pediatric Cardiology, Sakakibara Heart Institute, Japan Research Promotion Society for Cardiovascular Diseases ◇ 〒183-0003 東京都府中市朝日町三丁目16番1号Asahi-cho 3-16-1, Fuchu-shi, Tokyo 183-0003, Japan

5静岡県立こども病院循環器科Department of Cardiology, Shizuoka Children's Hospital ◇ 〒420-8660 静岡県静岡市葵区漆山860番地Urushiyama 860, Aoi-ku, Shizuoka-shi, Shizuoka 420-8660, Japan

受付日:2015年4月11日Received: April 11, 2015
受理日:2015年9月24日Accepted: September 24, 2015
発行日:2015年11月1日Published: November 1, 2015

二心室修復における右室流出路に対するステント留置には,Fallot四徴症で術前に姑息的に行われる場合と,術後に右室流出路の人工導管狭窄で導管の寿命延長を目的として行われる場合がある.術後の人工導管狭窄に対しては,2000年代以降に北米から多数例の報告があり,導管寿命を延長する効果が報告されているが,肺動脈弁逆流の増悪,冠動脈圧迫,ステント破壊などの問題がある.海外ではカテーテル的肺動脈弁留置術(Transcatheter pulmonary valve implantation; TPVI)は認可を受けたが,TPVIの適応を満たさない小径の導管では従来のステント留置が行われている.右室流出路の人工導管狭窄に対するステント留置の現状と問題点,日本における同手技の今後の役割に関して概説する.

In biventricular physiology, transcatheter right ventricular outflow tract (RVOT) stenting is indicated as an initial palliative alternative to a modified Blalock-Taussig shunt or to delay surgery for obstructed RVOT conduit. RVOT conduits may eventually need replacing because of luminal narrowing, regurgitation, or size mismatch associated with somatic growth. During the 2000s, reports from North America described acutely improved hemodynamics and the ability to postpone surgical replacement for 2.1–3.9 years with endovascular stenting for conduit stenosis. However, common complications of stenting RVOT conduits are free pulmonary regurgitation and frequent stent fracture. In addition, the potential risk of proximal coronary artery compression also limits its use when the anatomy is unfavorable. Recently, transcatheter pulmonary valve implants (TPVI), intended for treating RVOT conduit dysfunction, have become available in Europe and the US. However, size considerations may limit their use to smaller sized RVOT conduits. These uncertainties mean that stenting and surgery will remain necessary therapeutic options for conduit pathology, particularly in Japan where TPVI is unavailable. Given the likelihood of its continued use, we reviewed current trends in stenting for RVOT conduits in Japan and their potential risks and benefits.

Key words: catheter intervention; stent; right ventricle outflow tract conduit; conduit stenosis; pulmonary stenosis

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