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): 36-45 (2020)
doi:10.9794/jspccs.36.36

ReviewReview

先天性横隔膜ヘルニアのラット胎仔心臓肺断面像Fetal Heart and Lung Cross-Sectional Morphology of Congenital Diaphragmatic Hernia in the Rat

東京女子医科大学循環器小児科Department of Pediatric Cardiology, Tokyo Women’s Medical University ◇ Tokyo, Japan

発行日:2020年3月1日Published: March 1, 2020
HTMLPDFEPUB3

Bis-diamineは強力なteratogenで,ラットでほぼ前例に胸腺低形成と先天性心疾患を生じ,その一部に横隔膜ヘルニアを合併する.Bis-diamine 200 mgを妊娠9日と10日にラット40匹に胃内注入し,満期21日目の胎仔で全身急速凍結法,凍結ミクロトーム,実体顕微鏡(Wild M400)を用いて0.5 mm毎の胸部横断面を連続写眞で記録した.300胎仔に胸腺低形成(100%),各種先天性心疾患(90%),横隔膜ヘルニア(40%)(左側100例,右側20例)を生じた.左側横隔膜ヘルニアの写真の記録から次の所見が得られた.ヘルニア孔により主に肝臓が左胸郭に入り込み,肺と心臓は圧排されて低形成であった.軽度のヘルニアでは肝臓の左頭側部がわずかに左胸郭背側に入るだけで左肺の低形成は軽度で右肺と心臓の低形成はなかった.中程度ヘルニアでは肝臓が左胸郭中部と後部に入り左肺は半分になり,心臓は正中より右胸郭内に圧排されて小さくなり,右肺も軽度低形成であった.高度なヘルニア例では肝臓と胃が全左胸郭を占め,左肺は肺尖部に痕跡的に存在した.即ち,ヘルニアの程度に応じた肺低形成と心臓低形成が明らかであった.これらのラット胎生期横隔膜ヘルニアの胸郭横断面の天然色写真を提示する.

Bis-diamine was administered at a dose of 200 mg to 40 pregnant rats on the 9th and 10th days of gestation. Following cervical dislocation of these rats on the 21st day of gestation, the fetuses were delivered by cesarean section and then frozen immediately in acetone cooled to −76°C with dry ice. The thorax of each frozen fetus was cut transversely, and the section surface was serially photographed using a stereoscopic microscope (Wild M400 Photomacroscope) at every 500 µm. Among 300 fetuses, congenital heart disease (90%), thymic hypoplasia (100%), and diaphragmatic hernia (40%) were identified. In the 120 fetuses with diaphragmatic hernia, pulmonary and cardiac hypoplasias were recorded as follows. The liver and stomach occupied the left thorax; the heart deviated to the right and was hypoplastic. The left lung was hypoplastic as a result of the invasion of the liver and stomach into the left hemithorax. In cases with the most severe hernia, the liver and stomach occupied the total left hemithorax, resulting in minimal residual left lung. The right lung was also hypoplastic due to a rightward shift of the cardiac and mediastinal structures. In mild cases, only a small portion of the liver invaded the left posterior hemithorax, with mild hypoplasia of the left lung, normal right lung, and near-normal heart structures. These pictures clearly show the variability in cardiopulmonary hypoplasia due to the invading abdominal organs into the left hemithorax.

Key words: congenital diaphragmatic hernia; fetal echocardiography; pulmonary hypoplasia; cardiac hypoplasia; neonatal pulmonary hypertension

This page was created on 2020-03-23T16:18:58.107+09:00
This page was last modified on 2020-04-24T14:34:27.000+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。