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
Pediatric Cardiology and Cardiac Surgery 33(6): 423-430 (2017)
doi:10.9794/jspccs.33.423

原著Original

狭小な心房間交通を有する左心低形成症候群に対するBalloon Atrial Septostomyの検討Balloon Atrial Septostomy in Infants with Hypoplastic Left Heart Syndrome with Restrictive Atrial Septum

福嶋 遥佑1，馬場 健児1，近藤 麻衣子1，栗田 佳彦1，栄徳 隆裕1，重光 祐輔1，平井 健太1，塚原 宏一1，岩崎 達雄2，佐野 俊二3，笠原 真悟3，小谷 恭弘3，大月 審一1Yosuke Fukushima1, Kenji Baba1, Maiko Kondo1, Yoshihiko Kurita1, Takahiro Eitoku1, Yusuke Shigemitsu1, Kenta Hirai1, Koichi Tsukahara1, Tatsuo Iwasaki2, Shunji Sano3, Shingo Kasahara3, Yasuhiro Kotani3, Shinichi Otsuki1

1 岡山大学病院小児科・小児循環器科Okayama University Hospital, Pediatric Cardiology ◇ Okayama, Japan

2 岡山大学病院小児麻酔科Okayama University Hospital, Pediatrics ◇ Okayama, Japan

3 岡山大学病院心臓血管外科Okayama University Hospital, Cardiovascular Surgery ◇ Okayama, Japan

受付日：2017年4月21日Received: April 21, 2017
受理日：2017年11月24日Accepted: November 24, 2017
発行日：2017年11月1日Published: November 1, 2017
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背景：左心低形成症候群（HLHS）では左房容積が小さく，心房中隔の形態や心房中隔欠損（ASD）の大きさによってRashkind Balloon Atrial Septostomy（BAS）を行うことが困難な場合もある．

目的：当院におけるHLHSに対するBASの有効性について検討した．

対象と方法：2006年1月から2015年12月までの10年間にHLHSに対してカテーテル治療・手術を施行した患者におけるBASの有効性について検討した．またcatheter BASを施行した群についてASDの形態別に分けて有効性について両群比較検討した．

結果：全HLHS70例中のGlenn手術到達は57例（81％）であり，BAS未施行群では86％（44/51），catheter BAS群では91％（10/11），open BAS群では25％（2/8）と統計学的有意差を認めたが（p＝0.0002），BAS未施行群とcatheter BAS群では同等の結果であった．（p＝1.0）Glenn手術後にカテーテル検査を施行した56例について検討すると，BAS未施行群，catheter BAS施行群，open BAS施行群の平均肺動脈圧，肺血管抵抗，PAIいずれも3群間に差は認めなかった．次にCatheter BAS施行群をASDの位置・大きさ・atrial septumの厚さからstandard ASD (n＝5), complex ASD（n＝5）に分類し，ASDの形態別にBAS施行方法を検討すると，standard ASD群では全例Rashkind BAS単独施行で効果を得たが，complex ASD群ではRashkind BAS単独施行症例は1例のみで，Static BASを先行させRashkind BASに到達した症例が4例であった（p＝0.048）．BAS後のASD size, ASD flow, SpO2は2群間で統計学的有意差を認めなかった．

結論：catheter BASは有効で，Glenn後のカテーテルデータではBAS未施行群と有意差は認めなかった．またcomplex ASD群の場合には，Static BASを先行し，Rashkind BASを追加することで，standard ASD群と同等の効果を得ることができた．

Background: Rashkind Balloon Atrial Septostomy (BAS) can be technically challenging if infants with Hypoplastic left heart syndrome (HLHS) also have unusual atrial septal anatomy or small ASD.

Objectives: To evaluate our institutional experience performing BAS in infants with HLHS.

Methods: We retrospectively reviewed infants with HLHS who underwent surgery and BAS between January 2006 and December 2015. The infants were divided into three groups: infants who did not require BAS, those who required catheter BAS, and those who required open BAS. Additionally, infants who underwent catheter BAS were divided into two groups: infants with standard atrial septal anatomy and those with complex atrial septal anatomy based on previous medical reports.

Results: Of the 70 cases, 57 infants (81％) underwent Glenn surgery. After Glenn surgery, a significant difference in survival rate was seen, with 86％ (44/51) in the no BAS group, 91％ (10/11) in the catheter BAS group, and 25％ (2/8) in the open BAS group (p＝0.0002). However, no significant difference was noted between the no BAS group and the catheter BAS group (p＝1.0). Considering the 56 patients who underwent catheterization after Glenn surgery, no differences were found between the three groups in mean pulmonary artery pressure, pulmonary vascular resistance, or pulmonary artery index. Additionally, we classified catheter BAS cases into the standard ASD group (n＝5) and the complex ASD group (n＝5) based on ASD location, ASD size, and atrial septum thickness. All cases in the standard group underwent complete Rashkind BAS, but in the complex ASD group, only one case underwent complete Rashkind BAS and the remaining cases required Rashkind BAS prior to Static BAS (p＝0.048). Following septostomy, ASD size, ASD flow, or SpO2 did not show statistically significant differences between the two groups.

Conclusions: Catheter BAS is effective in infants with HLHS with restrictive atrial septum. Hemodynamic data during catheterization after Glenn surgery in patients who required BAS were similar to those in patients who did not undergo BAS. Compared with infants with standard atrial septum, infants with complex atrial septum could have equivalent BAS outcomes even though more of them require static BAS.

Key words: hypoplastic left heart syndrome; balloon atrial septostomy; congenital heart disease

© 2017 特定非営利活動法人日本小児循環器学会© 2017 Japanese Society of Pediatric Cardiology and Cardiac Surgery

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