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(3): 241-246 (2020)
doi:10.9794/jspccs.36.241

症例報告Case Report

修正大血管転位症術後遠隔期に二弁置換術と同時に心室再同期療法を導入し有効であった一例Cardiac Resynchronization Therapy Pacemaker and Double Valve Replacements Improved Cardiac Function after Physiological Repair in a Patient with Congenitally Corrected Transposition of the Great Arteries

1九州大学病院心臓血管外科Department of Cardiovascular Surgery, Kyushu University Hospital ◇ Fukuoka, Japan

2九州大学病院循環器内科Department of Cardiology, Kyushu University Hospital ◇ Fukuoka, Japan

受付日:2019年12月26日Received: December 26, 2019
受理日:2020年3月4日Accepted: March 4, 2020
発行日:2020年10月1日Published: October 1, 2020
HTMLPDFEPUB3

修正大血管転位症の機能的修復術後は右心室が体心室となるため,遠隔期に右心不全,三尖弁閉鎖不全,不整脈などが問題となる.今回,機能的修復術後に,3回目の再開胸手術を施行した1例を経験したので報告する.症例は26歳の女性で,修正大血管転位症に対して3歳時にセントラルシャント手術を経て,10歳時に機能的修復術を施行された.20歳時に左室肺動脈導管再置換術を施行されたが,その後は心不全,不整脈のために入院治療を繰り返していた.今回,大動脈弁および三尖弁閉鎖不全症に対して,大動脈弁および三尖弁置換術を施行した.高度房室ブロックに対して永久ペースメーカー植え込み術後であったが,今回,左心室に心外膜リードを挿入し心室再同期療法を導入した.人工心肺離脱時には大動脈バルーンパンピングを要し,術後も長期のカテコラミン投与を要したが,術後60日目に自宅退院した.術後2年9か月現在,心不全の増悪なく経過している.

The morphological right ventricle supports systemic circulation following physiological repair of congenitally corrected transposition of the great arteries (ccTGA); however, complications such as failure of the right ventricle, tricuspid valve regurgitation, and arrhythmia can arise in adolescence and adulthood. Here, we report the case of a 26-year-old woman who underwent a 4th surgery after undergoing physiological repair for ccTGA. Previously, she underwent a shunt procedure at the age of 3, ccTGA repair at the age of 10, and replacement of the left ventricle to the pulmonary artery conduit when she was 20 years old. In recent years, she was frequently hospitalized due to acute heart failure and atrial tachyarrhythmia. After further examination, we performed aortic and tricuspid valve replacement, and upgraded her cardiac resynchronization therapy pacemaker (CRT-P). Her post-operative course was uneventful, although she was administered catecholamine for an extended duration. Electrocardiogram revealed a decreased duration of QRS from 204 ms to 112 ms, following the CRT-P upgrade, and her brain natriuretic peptide level also markedly improved. She is doing well 2 years and 9 months after the surgeries.

Key words: congenitally corrected transposition of great arteries; systemic right ventricle; cardiac resynchronization therapy pacemaker

This page was created on 2020-09-10T10:13:19.772+09:00
This page was last modified on 2020-10-19T15:42:08.000+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。