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): 328-334 (2016)
doi:10.9794/jspccs.32.328

症例報告Case Report

胎児心エコー所見をもとに早期娩出し救命できたハイリスク仙尾部奇形腫の胎児例Successful Preterm Delivery of a Fetus with High-risk Sacrococcygeal Teratoma Based on Fetal Echocardiographic Findings

1筑波大学医学医療系小児科Department of Child Health, Faculty of Medicine, University of Tsukuba ◇ Ibaraki, Japan

2筑波大学医学医療系産婦人科Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba ◇ Ibaraki, Japan

3筑波大学医学医療系小児外科Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba ◇ Ibaraki, Japan

受付日:2016年3月19日Received: March 19, 2016
受理日:2016年5月25日Accepted: May 25, 2016
発行日:2016年7月1日Published: July 1, 2016
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充実性の巨大な胎児仙尾部奇形腫は高心拍出性心不全を伴いやすく,胎児水腫に至ると致死率が上がる.急速に増大した仙尾部奇形腫を伴う胎児に対し,胎児心エコー所見に基づいて早期娩出を計画し,分娩直後に腫瘍摘出術を施行し,合併症なく救命できた胎児例を報告する.症例は妊娠19週の胎児.妊娠28週から30週にかけて腫瘍長径が11.2 cmから15.6 cmへと急速に増大した.胎児MRIでは腫瘍は充実性優位で骨盤腔内への進展のないタイプ(Altman I型)であった.30週の胎児心エコーでは胎児水腫はないが,両心拍出量は1,350 mL/kg/minと著明に増加していた.経時的に胎児心エコーを施行し,心拡大の進行,右室収縮能の低下,三尖弁閉鎖不全の出現,心拍出量の分布の変化を契機に32週3日に帝王切開と腫瘍摘出術を施行した結果,後遺症なく胎児を救命することができた.ハイリスクの胎児仙尾部奇形腫は治療介入のタイミングが胎児の予後を左右するため,胎児心エコーによる継時的な血行動態評価が不可欠と考えられた.

A solid giant sacrococcygeal teratoma (SCT) may cause high-output heart failure in a fetus. The mortality rate increases with the development of fetal hydrops. In this study, we report a case of a rapidly growing fetal SCT, in which early delivery was carried out based on fetal echocardiography findings. Tumor resection immediately after delivery resulted in survival of the baby. The mother was referred to our hospital at 19 weeks of gestation. The tumor length increased rapidly from 11.2 cm at 29 weeks to 15.6 cm at 30 weeks. Fetal magnetic resonance imaging showed a large, predominantly solid type of SCT without extension into the pelvic space (Altman type I). At 30 weeks, the fetal combined cardiac output was elevated to 1,350 mL/kg/min, but no signs of hydrops were observed. After repeated evaluation with fetal echocardiography, a cesarean section was conducted at 32 weeks and 3 days. This decision was based on progressive cardiomegaly, development of right ventricular dysfunction and tricuspid regurgitation, and abnormal distribution of cardiac output. Intervention timing plays a critical role in the survival of a fetus with high-risk SCT, and repeated echocardiographic evaluation of the fetal cardiovascular dynamics is essential.

Key words: giant sacrococcygeal teratoma; high-output heart failure; fetal echocardiography; preterm delivery

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