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): 340-344 (2015)
doi:10.9794/jspccs.31.340

原著Original

乳児期後期Rastelli型手術における16 mm自作3弁付きePTFE導管の中期遠隔成績Mid-term Results of Right Ventricular Outflow Tract Reconstruction using 16-mm Hand-made Trileaflet Expanded Polytetrafluoroethylene Conduits in Approximately 1-Year-Old Infants

1岩手医科大学附属病院循環器医療センター心臓血管外科Department of Cardiovascular Surgery, Memorial Heart Center, Iwate Medical University Hospital ◇ 〒020-8505 岩手県盛岡市内丸19番1号Uchimaru 19-1, Morioka-shi, Iwate 020-8505, Japan

2岩手医科大学附属病院循環器医療センター小児循環器科Department of Pediatric Cardiology, Memorial Heart Center, Iwate Medical University Hospital ◇ 〒020-8505 岩手県盛岡市内丸19番1号Uchimaru 19-1, Morioka-shi, Iwate 020-8505, Japan

受付日:2015年4月13日Received: April 13, 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
HTMLPDFEPUB3

背景:新生児乳児期のRastelli型手術では将来の導管交換は必至である.

目的:当院では姑息術を経て乳児期後期に16 mm自作3弁付きexpanded polytetrafluoroethylene(ePTFE)導管を使用したRastelli型手術を施行している.その中期遠隔成績を検討した.

方法:対象は2007~2013年までに上記手術を施行した9例.年齢17.3ヶ月,体重8.9 kg,診断DORV,PS4例,PA,VSD,MAPCA4例,PA,VSD1例.

結果:急性期遠隔期死亡なし.術後平均経過観察期間45ヶ月で導管バルーン拡張術2例(術後47,51ヶ月).うち1例は導管交換術施行(初回手術後78ヶ月,バルーン拡張後27ヶ月).導管交換例を除いた,最新のエコー所見は導管内圧較差0~20 mmHg:4例,21~40 mmHg:4例,41 mmHg以上:0例,導管内逆流は微量:4例,軽度:2例,中等度:2例.

結論:乳児期後期Rastelli型手術における16 mm自作3弁付きePTFE導管の中期遠隔成績は許容できるものであった.導管狭窄に対するバルーン拡張術は導管交換を遅延できる可能性が示唆された.

Background: In small children, conduits for right ventricular outflow tract reconstruction are limited because of patient size and conduit resources, particularly in Japan.

Methods: Since 2007, we have performed the Rastelli-type procedure using 16-mm hand-made trileaflet expanded polytetrafluoroethylene (ePTFE) conduits in nine approximately 1-year-old children. The median age and body weight at surgery was 17.3 months (range: 10~22 months) and 8.9 kg (range: 6.8~11 kg), respectively. The patient diagnoses were double-outlet right ventricle (DORV) with pulmonary stenosis (PS) in four, pulmonary atresia with ventricular septal defect (PA/VSD) and major aortopulmonary collateral arteries (MAPCA) in four, and PA/VSD in one patient. All patients had undergone previous surgical procedures, including modified Blalock shunt in five and unifocalization of MAPCA and modified Blalock shunt in four patients. Conduit function, re-intervention, and right ventricular function were retrospectively investigated.

Results: There was no early or late mortality. During the median follow-up of 45 months (range: 18~79 months), balloon dilation for conduit stenosis was performed in two patients at 47 and 51 months post surgery, respectively. One of these patients required conduit replacement 27 months after balloon dilation. Excluding this patient, the most recent echocardiographic pressure gradients of the conduits were 0~20 mmHg in four, 21~40 mmHg in four, and no patient had conduit stenosis with the pressure gradients over 41 mmHg. Conduit regurgitation was trivial in four, mild in two, and moderate in two patients.

Conclusion: The Rastelli-type procedure using 16-mm hand-made trileaflet ePTFE conduits in approximately 1-year-old infants showed acceptable mid-term results. Conduit stenosis gradually developed over 5~6 years. Balloon dilation for conduit stenosis has the potential to delay conduit replacement without increasing conduit regurgitation.

Key words: expanded polytetrafluoroethylene conduit; Rastelli-type procedure; right ventricular outflow reconstruction; conduit replacement

This page was created on 2015-11-02T16:59:33.843+09:00
This page was last modified on 2015-11-27T16:00:18.458+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。