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(4): 270-276 (2016)
doi:10.9794/jspccs.32.270

ReviewReview

Fetal Cardiac Intervention:過去・現在・未来Fetal Cardiac Intervention: Past, Present and Future

長野県立こども病院小児集中治療科Department of Pediatric Intensive Care, Nagano Childrenʼs Hospital ◇ Nagano, Japan

発行日:2016年7月1日Published: July 1, 2016
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Fetal Cardiac Intervention(侵襲的胎児心臓治療)は,この20年間で欧米を中心に進歩してきた.形態異常による胎内で不可逆性の心血管変化を予防することを目的とし,その技術・適応・効果が世界中の胎児心臓医の挑戦により徐々に明らかになってきている.治療法は経母体腹壁から直接心臓を穿刺して行われ,胎児に対する侵襲度・術者の技術的ハードルは高い.治療は重症大動脈弁狭窄症,心室中隔欠損を伴わない肺動脈閉鎖症,心房間交通狭小化を呈する左心低形成症候群といった重症先天性心疾患が対象となる.疾患により適応・効果は異なり,治療の有効性は更なる解明が必要である.Fetal Cardiac Interventionは胎児心臓病学の一端を担う分野であり,本邦における早急の体制整備・治療開始が望まれる.

Fetal cardiac intervention has developed over the last two decades in Europe and North America to prevent irreversible deterioration in the fetal heart caused by morphological cardiac malformation. Technique, patient selection, and effects of the intervention have been clarified through challenges faced by fetal cardiologists worldwide. The intervention is performed by direct puncture of the fetal heart through the maternal abdomen. The procedure is significantly invasive for the fetus and requires a high level of surgical skill. Severe congenital heart diseases, including critical aortic stenosis, pulmonary atresia with intact ventricular septum, and hypoplastic left heart syndrome with highly restrictive foramen ovale, are targets for the intervention. Fetal cardiac intervention is an important treatment for severe congenital heart disease in utero and is desired early introduction into clinical practice in Japan.

Key words: fetal cardiac intervention; fetal balloon aortic valvuloplasty; fetal balloon pulmonary valvuloplasty; fetal balloon atrial septoplasty; fetal cardiac pacing

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