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 35(4): 228-237 (2019)


胎児期に先天性心疾患出生後の重症度をどう評価する?Estimation Method for the Severity of Postnatal Congenital Heart Disease from Assessments Made during the Fetal Period

1市立豊中病院小児科Department of Pediatrics, Toyonaka Municipal Hospital ◇ Osaka, Japan

2大阪母子医療センター小児循環器科Department of Pediatric Cardiology, Osaka Women’s and Children’s Hospital ◇ Osaka, Japan

発行日:2019年11月1日Published: November 1, 2019

近年では胎児心エコー検査による先天性心疾患(CHD)の診断例が増加している.日本の胎児心エコー検査は,胎児心スクリーニングである「レベル1」と胎児心精査である「レベル2」に分けられ,小児循環器医は主に「レベル2」胎児心エコー検査を担っている.そしてレベル2胎児心エコー検査による診断スキルが上昇した結果,診断ばかりでなく疾患の「重症度の評価」まで求められる時代となった.重症度の評価としては,1. 疾患名での重症度分類と,2. 疾患ごとでの重症度判定,とに分けられる.1については,AllanLDによって胎児CHDを1–10の重症度に分けた分類スケールや,塩野らによる胎児心臓トリアージ表が参考になる.2については,それぞれの疾患群の中で異なる重症度を評価するためのポイントの認識や計測が必要となる.小児循環器学の中でも胎児心臓病学を学び,レベル2胎児心エコー認証医となるにはこのような重症度の評価を理解しておくことが重要である.

In recent years, there have been an increasing number of fetuses diagnosed by fetal echocardiography as having congenital heart disease (CHD). Fetal echocardiography in Japan is divided into 2 levels: Level 1–fetal heart screening and Level 2–detailed fetal heart examinations. Pediatric cardiologists are mainly responsible for Level 2 fetal echocardiography. As a result of improved diagnosis of Level 2 fetal echocardiography, both the diagnosis and “assessment of the severity of the disease” are now required. There are two categories of severity: 1) Severity classification by CHD type and 2) Severity determination in each case of the disease. For category 1, assessment can be made by reference to the CHD classification scale developed by Allan LD (in which the severity of fetal CHD is measured on a scale of 1 to 10) and/or to the fetal heart triage chart by Shiono et al. For category 2, it is necessary to recognize and measure the points for evaluating the differences in severity within each disease group. It is important for fetal cardiologists to understand such severity assessments, and it is now essential to become a certified Level 2 fetal echocardiologist.

Key words: prenatal diagnosis; congenital heart disease; fetal echocardiography; severity

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