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 32(2): 114-121 (2016)
doi:10.9794/jspccs.32.114

ReviewReview

先天性心疾患の外科治療:冠動脈関連の合併症をいかに避けるかSurgical Treatment of Congenital Heart Disease: How Do We Avoid Coronary-related Complications?

福岡市立こども病院心臓血管外科Cardiovascular Surgery, Fukuoka Children’s Hospital ◇ Fukuoka, Japan

発行日:2016年3月1日Published: March 1, 2016
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先天性心疾患の外科治療における周術期の冠動脈関連合併症の原因は手術手技そのものによるものと疾患自体が持つ特性によるものがある.前者は完全大血管転位症や大血管転位型両大血管右室起始症に対する動脈スイッチ手術に代表される.動脈スイッチ手術における安全な冠動脈移植には冠動脈の走行パターンのみならず冠動脈移植方法,また大血管の位置関係や肺動脈の再建方法を総括して考えなければならない.また後者では右室—冠動脈類洞交通を伴うPulmonary atresia-intact ventricular septum(PA-IVS)が最も重要である.術中にいかに冠動脈血流を維持し心筋虚血を防ぐかに重点を置き手術術式と体外循環法を考える必要がある.その他,ファロー四徴症などの疾患にも冠動脈走行異常が少なからず存在することを念頭に置き,術前検査と術中の確認,術式の選択に注意を払う必要がある.

The cause of perioperative coronary-related complications in congenital heart surgery is either procedure-related or an attribute of the disease itself. The representative example of the former is an arterial switch operation for the transposition of the great arteries or double outlet right ventricle. In performing safe and adequate coronary transplantation, careful observation of not only the coronary patterns but also coronary transplantation method, spatial relationship of the great arteries, and the method of pulmonary artery reconstruction are comprehensively considered. In contrast, an example of the latter is pulmonary atresia with an intact ventricular septum associated with the right ventricle-coronary sinusoidal communication. To avoid perioperative coronary ischemia, special attention must be paid to intraoperative management, including the perfusion and operative methods. In addition to obtain a precise preoperative diagnosis and careful intraoperative observation, the awareness about the fact that many congenital heart diseases could have a coronary anomaly may help to avoid coronary-related complications in congenital heart surgery.

Key words: congenital heart disease; surgery; coronary; complication

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This page was last modified on 2016-04-12T11:43:14.254+09:00


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