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(5): 417-422 (2016)
doi:10.9794/jspccs.32.417

原著Original

大動脈弓下狭小例に対する自己組織によるascending aortic extension法の中期遠隔成績:5例の経験Mid-term Results of an Ascending Aortic Extension and Plication Technique for Narrowing the Retroaortic Space: Five Cases

1独立行政法人地域医療機能推進機構 中京病院こどもハートセンター心臓血管外科Department of Cardiovascular Surgery, Chukyo Children Heart Center, 
Japan Community Healthcare Organization Chukyo Hospital ◇ Aichi, Japan

2独立行政法人地域医療機能推進機構 中京病院こどもハートセンター小児循環器科Department of Pediatric Cardiology, Chukyo Children Heart Center, 
Japan Community Healthcare Organization Chukyo Hospital ◇ Aichi, Japan

3豊橋市民病院心臓外科Department of Cardiac Surgery, Toyohashi Municipal Hospital ◇ Aichi, Japan

受付日:2016年5月11日Received: May 11, 2016
受理日:2016年7月14日Accepted: July 14, 2016
発行日:2016年9月1日Published: September 1, 2016
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背景:主肺動脈の狭窄や閉鎖を伴う多くのチアノーゼ性心疾患では,上行大動脈の拡大と弓下の空間の狭小化が見られ根治術を困難にする.この問題に対する手術方法として,自己大動脈組織によるaortic extension法を考案した.

方法:本術式を2005年から2013年までに肺動脈閉鎖兼心室中隔欠損症の1例と機能的単心室の4例の計5例に行い,手術時データ,予後,術前後大動脈造影検査で大動脈径の変化につき比較,検討した.

結果:手術時年齢は18.2±7.6か月(7か月~2歳),体重は8.4±0.9 kg(7.1~10.0 kg)で,手技としては全例30分程度で施行可能だった.術前後の上行大動脈最大径/上行大動脈末梢径比は1.64±0.22から1.01±0.36に有意に減少し弓下の拡大がえられた.術後観察期間は53.8±38.3か月(32~130か月)で,狭窄や再拡大は認めず経過良好だった.

結論:自己大動脈組織のみによるaortic extension法は,大動脈径の縮小と延長が同時に可能で,成長も期待でき十分な弓下拡大による太い中心肺動脈再建や気管支の圧迫解除を可能にする有用な術式と考えられた.

Background: In many cases of cyanotic congenital heart disease with pulmonary atresia or stenosis, the ascending aorta is larger than normal. This enlarged aorta reduces the retroaortic space and makes corrective surgery difficult. To overcome this problem, we devised an aortic extension using only the self-aortic tissue.

Methods: Between 2005 and 2013, we performed this procedure in five patients: four with a functional single ventricle and one with pulmonary atresia and ventricular septal defect. Operative data, prognosis, and change in the aortic diameter were examined postoperatively.

Results: Mean patient age at the time of surgery was 18.2±7.6 months (range, from 7 months to 2 years) and mean body weight was 8.4±0.9 (range, 7.1–10.0) kg. The aortic extension procedure was performed in approximately 30 min in all cases. The ratio of the maximum to peripheral diameter of the ascending aorta was 1.64±0.22 preoperatively and was significantly reduced to 1.01±0.36 postoperatively. No stenosis or re-enlargement was observed over 53.8±38.3 (range, 32–130) months postoperatively.

Conclusion: This aortic extension procedure without the use of a prosthetic graft or autograft enlarges the retroaortic space by extending and plicating the ascending aorta and allows decompression of the central pulmonary artery and bronchus. It also has potential for growth of the aorta.

Key words: ascending aortic extension; plication; retroaortic space; mid-term result

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