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(1): 23-35 (2020)
doi:10.9794/jspccs.36.23

ReviewReview

経カテーテル肺動脈弁留置術Transcatheter Pulmonary Valve Replacement

公益財団法人日本心臓血圧研究振興会附属榊原記念病院循環器内科Department of Cardiology, Sakakibara Heart Institute ◇ Tokyo, Japan

発行日:2020年3月1日Published: March 1, 2020
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経皮的肺動脈弁バルーン拡張術(Balloon pulmonary valvuloplasty: BPV)はテクノロジーと共に進化を遂げ,現在では外科的肺動脈弁拡張術を凌ぐ成績を納め,肺動脈弁狭窄に対する標準治療となった.2000年にフランスのBonhoefferらが右室流出路—肺動脈導管の機能不全に対してpercutaneous pulmonary valve implantation (PPVI)を成功させ,2010年にはMelody valve (Medtronic, Minneapolis, MN)が米国Food and Drug Administration (FDA)の承認を受け,臨床で広く使われるようになった.また成人領域で行われているTranscatheter aortic valve replacement (TAVR)の技術をもとに近年,自己の右室流出路に対するカテーテル治療,そして弁置換後(肺動脈弁位のみならず大動脈弁,僧帽弁,三尖弁位)のValve-in-valveの有効性が示された.本邦の外科手術の成績は優れているが,複数回の開胸歴や併存症のため,手術リスクが高い患者は周術期のイベントを起こす可能性が高いだけでなく,無事手術が終わってもその後,長期入院を要することもある.成人領域と同様,この領域においても小児循環器医,小児心臓外科医,循環器内科医,コメディカルがハートチームを意識し,ACHD患者を総括的に診療する必要がある.本稿ではPPVIの治療適応(肺動脈狭窄と閉鎖不全の両者),手技の詳細,起こりうる合併症等について過去の報告,本邦の臨床経験を踏まえReviewを行う.

Since percutaneous balloon pulmonary valvuloplasty for pulmonary valve stenosis (PS) was first successfully performed using a ureteral catheter in 1950s, BPV has become standard of care for treatment of isolated PS over surgical valvotomy. Based on the experience, percutaneous pulmonary valve implantation (PPVI) was performed by Bonhoeffer et al. in patient with a dysfunctional of right ventricle-to-pulmonary artery conduit. In 2010, the Melody valve (Medtronic, Minneapolis, MN) became commercially available in the United States (US) under a humanitarian device exemption protocol, and more recently, was awarded post market approval by the US Food and Drug Administration. Since then, PPVI has been performed for over 4,500 patients in more than 30 countries worldwide. Transcatheter aortic valve replacement (TAVR) has recently became the standard therapy in patients with aortic stensis, and based on this technology, transcatheter pulmonary valve replacement (TPVR) and valve-in-valve procedure has also been able to be performed in patients with adult congenital heart disease. In conformity with heart team approach, hybrid procedures with mutual collaboration from cardiac surgery and interventional cardiology will likely shape the future TPVR. In this chapter, we will review BPV and PPVI/TPVR with particular focus on the indication, technical aspect, clinical outcomes, and potential complications.

Key words: PPVI; TPVR; ACHD; Heart team; new technology; GUCH

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This page was last modified on 2020-04-24T14:30:32.000+09:00


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