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 33(5): 395-403 (2017)
doi:10.9794/jspccs.33.395

原著Original

小児期に留置した心房中隔欠損症に対するAmplatzer Septal Occluderデバイスの心房機能に与える影響The Impact of an Implanted Device on Atrial Function after Percutaneous Closure of Atrial Septal Defect Using an Amplatzer Septal Occluder in Infants

1長野県立こども病院エコーセンターNagano Children’s Hospital, Echo Center ◇ Nagano, Japan

2長野県立こども病院循環器センターNagano Children’s Hospital, Cardiovascular Center ◇ Nagano, Japan

3長野県立こども病院循環器小児科Nagano Children’s Hospital, Division of Pediatric Cardiology ◇ Nagano, Japan

4長野県立こども病院臨床検査科Nagano Children’s Hospital, Division of Clinical Laboratory ◇ Nagano, Japan

受付日:2017年1月12日Received: January 12, 2017
受理日:2017年10月18日Accepted: October 18, 2017
発行日:2017年9月1日Published: September 1, 2017
HTMLPDFEPUB3

背景:二次孔型心房中隔欠損症(ASD)に対するAmplatzer Septal Occluderを用いた経皮的閉鎖術治療(ASO)において,心房中隔に留置された伸縮性に乏しいデバイスの中長期的な心機能への影響については不明な点が多い.この研究では,ASOの左房および右房機能に与える短期的および中期的影響について検討した.

対象と方法:ASD 45例中ASO群30例,外科的閉鎖術群(SC)15例と正常小児対照群(NC)15例を対象とした.ASO群は,閉鎖栓サイズの心房中隔長に占める割合の大小でさらに2つのサブグループに分類した.計測項目は,経胸壁心エコーの心尖部四腔断面から左房(LA)と右房(RA)の最大面積(Max),最小面積(Min).さらに心房reservoir機能の指標として,心房伸展性Distensibility (Dis)[=(Max−Min)/Min]を検討した.

結果:LA Disは,NC群(1.51±0.25)に比べASO群(1.10±0.22)とSC群(1.0±0.44)で有意に低下していた.特に閉鎖栓サイズが大きな群でよりLA Disは低下していた.一方,RA Disは,ASO群(0.87±0.27)とSC群(0.59±0.24)で,NC群(1.38±0.37)より低下していたが,閉鎖栓サイズの大小とは無関係であった.

最大心房面積は左右ともASO群とNC群で差はなかったが,最小心房面積は,ASO群のほうがNC群より大きかった.

結語:左右心房の伸展性が,ASO群およびSC群でNC群より低下していたことから,ASO治療後および外科手術後では心房性不整脈の発生など長期的な心房機能の評価と長期的予後のための経過観察が必要と思われる.

Background: The impact of device closure using an Amplatzer Septal Occluder (ASO) on atrial function in patients with atrial septal defect (ASD) remains unknown. This study aimed to clarify the short- and mid-term changes of left atrial (LA) and right atrial (RA) function after ASO implantation.

Methods: Forty-five patients with secundum-type ASD (30 treated by ASO and 15 treated by surgical closure [SC]) and 15 normal children (NC) as controls were investigated. The maximum (Max) and minimum (Min) areas of both atria were measured from the apical four-chamber view via transthoracic echocardiography, and atrial distensibility (Dis) was calculated as (Max−Min)/Min. The ASO group was further divided into two groups based on the ratio of device length to total atrial septal length (D/L) as follows: L-ASO (>0.85) and S-ASO (<0.85).

Results: LA Dis was significantly reduced in the ASO (1.10±0.22) and SC groups (1.0±0.44) compared to that in the NC group (1.51±0.25) (p<0.001), and the rate of reduction was related to D/L in the ASO group. RA Dis was also lower in the ASO (0.87±0.27) and SC groups (0.59±0.24) than in the NC group (1.38±0.37), but the difference was not related to D/L. Max for both atria was similar between the ASO and NC groups whereas Min was elevated for both atria in the ASO group.

Conclusion: Dis declined with D/L in both atria in the ASO and SC groups, and longer follow-up of atrial functions is needed to clarify the potential risk of atrial arrhythmia or dysfunction.

Key words: atrial septal defect; device closure; atrial function; echocardiography

This page was created on 2017-10-25T17:40:19.622+09:00
This page was last modified on 2017-10-31T17:20:34.312+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。