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 36(2): 133-142 (2020)
doi:10.9794/jspccs.36.133

原著Original

新生児・乳児早期の症候性動脈管開存症に対するカテーテル治療の有効性と安全性Transcatheter Closure in Symptomatic Neonates and Young Infants with Patent Ductus Arteriosus

1独立行政法人地域医療機能推進機構 九州病院小児科Department of Pediatrics, Kyushu Hospital, Community Healthcare Organization ◇ Fukuoka, Japan

2独立行政法人地域医療機能推進機構 九州病院心臓血管外科Cardiovascular Surgery, Kyushu Hospital, Community Healthcare Organization ◇ Fukuoka, Japan

3大分県立病院小児科Department of Pediatrics, Oita Prefectural Hospital ◇ Oita, Japan

4産業医科大学病院小児科Department of Pediatrics, Occupational and Environmental Health University Hospital ◇ Fukuoka, Japan

5独立行政法人国立病院機構 小倉病院小児科Department of Pediatrics, Kokura Medical Center ◇ Fukuoka, Japan

受付日:2019年11月7日Received: November 7, 2019
受理日:2020年2月6日Accepted: February 6, 2020
発行日:2020年6月1日Published: June 1, 2020
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背景:新生児・乳児早期の動脈管開存症(PDA)に対するカテーテル治療の有効性と安全性について検討する.

対象と方法:新生児・乳児早期(生後6か月以下)の症候性PDA25例中,カテーテル治療15例と外科治療10例に関して,臨床経過と合併症に関して後方視的に比較検討した.

結果:日齢115日(6~212),体重4.20 kg (1.62~8.79),肺体血流比3.54 (1.06~8.80),平均肺動脈圧28 mmHg (12~60),PDA径4.3 mm (1.1~8.8)であり2群間差はなかった.カテーテル治療群の使用デバイスはAmplatzer™ Duct Occluder (ADO) 8例,ADO-II 1例,Amplatzer™ Vscular Plug-II (AVP-II) 6例であった.カテーテル治療群では術前リスクの高い症例(人工呼吸管理4例,肺出血3例など)が目立った.カテーテル治療群のうち2例は技術的困難なため断念し外科治療となった.重大合併症はカテーテル治療群4例(デバイス脱落1例,輸血2例,術後肺炎1例)に対して外科治療群3例(乳び胸1例,呼吸不全1例,大動脈縮窄1例)であり,2群間に有意差はなかった.

結語:新生児・乳児早期PDAに対するカテーテル治療は外科治療と遜色ない有効性・安全性であり,高リスクな症例に対しても実施することが可能である.カテーテル治療と外科治療の利点を考慮し慎重な適応選択が望ましい.

Background: We aimed to study the efficacy and safety of transcatheter closure of the ductus among neonates and young infants with patent ductus arteriosus (PDA).

Patients and Methods: Of 25 subjects with PDA, we compared the adverse events in 15 patients who underwent transcatheter closure and 10 patients who underwent surgical closure.

Results: Age (115 days, range 6–212) and weight (4.20 kg, 1.62–8.79) at procedure, pulmonary to systemic flow ratio (3.54, 1.06–8.08), mean pulmonary arterial pressure (28 mmHg, 12–60), and ductal diameter (4.3 mm, 1.1–8.8) did not significantly differ between the groups. Within the transcatheter closure group, we used Amplatzer™ Duct Occluder (ADO) in 8, ADO-II in 1, and Amplatzer™ Vascular Plug-II (AVP-II) in 6 patients. Complete occlusions were attained in all but 2 patients, following successful surgical closure. There were 4 major adverse events in the transcatheter closure group (1 device migration, 2 transfusions, 1 pneumonia) and 3 major adverse events in the surgical closure group (1 chylothorax, 1 respiratory failure, 1 coarctation), which did not differ between the groups. There were no deaths related to either procedure.

Conclusions: transcatheter closure is feasible, but the risks of major adverse events were noteworthy.

Key words: congenital heart disease; catheter intervention; surgery; complication

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This page was last modified on 2020-06-19T11:28:11.000+09:00


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