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 37(2): 106-116 (2021)
doi:10.9794/jspccs.37.106

原著Original

Fontan導管への経皮的穿刺・開窓術の方法とその臨床効果Methods for and Clinical Effects of Trans-Catheter Puncture and Fenestration to Fontan Conduit

静岡県立こども病院循環器科Department of Cardiology, Shizuoka Children’s Hospital ◇ Shizuoka, Japan

受付日:2020年9月10日Received: September 10, 2020
受理日:2021年2月18日Accepted: February 18, 2021
発行日:2021年8月1日Published: August 1, 2021
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背景:単心室疾患の治療成績が上昇し,Fontan患者は年々増加している.しかし,Fontan術後に不整脈やfailing Fontan状態などの様々な遠隔期合併症に苦しむ患者も多い.このような問題に対するカテーテル治療として,Fontan導管への経皮的穿刺・開窓術(transcatheter puncture and fenestration: TPF)を行うことがあるが,その効果・合併症についての報告は少ない.

方法:当院にてTPFを行った7症例(9件)を対象として,カテーテル治療の効果・合併症について後方視的に検討した.

結果:全9件のカテーテル治療の適応の内訳は,不整脈が4症例(5件),鋳型気管支炎(plastic bronchitis: PB)が3症例(3件),蛋白漏出性胃腸症(protein-losing enteropathy: PLE)が1症例(1件)であった.PBとPLEの症例は開窓部分にステント留置を行い,3/4件で静脈圧が低下した.不整脈に対するアブレーションは5/5件で成功した.総カテーテル時間(中央値)は243分(194~420分)と長時間であった.

結論:TPFは開心術を要さずに,Fontan術後の問題を解決しうる治療方法であり,Fontan患者の予後改善に寄与する可能性がある.

Background: With improved treatment of single ventricle physiology, Fontan-type repaired cases are continuously increasing. After Fontan procedures, patients may have severe complications such as supraventricular tachyarrhythmia or failing Fontan circulation. Trans-catheter puncture and fenestration (TPF) to the Fontan conduit have been used as a catheter treatment to address these complications. Due to the technical challenges of the procedures, there are few reports on the effects of trans-catheter re-interventions and the possible complications.

Methods: We retrospectively reviewed the effects and complications of TPF in 7 cases (a total of 9 procedures) performed from 2010 to 2019 in our hospital.

Results: The indications for catheter treatment were: (1) supraventricular tachyarrhythmia (n=4, with 5 procedures); (2) plastic bronchitis (PB) (n=3); and (3) protein-losing gastroenteropathy (PLE) (n=1). In cases of PB and PLE, stent implantation was added into the percutaneously created fenestration. In 3 out of 4 cases, a decrease in central venous pressure was confirmed. Ablation was successful with an efficient catheter approach in all cases. All 9 TPF procedures were completed without complications.

Conclusions: TPF is a feasible and safe therapeutic option compared to open-heart surgery. Additionally, it has a potential for improving specific complications after Fontan completion.

Key words: Fontan; fenestration; plastic bronchitis; protein-losing enteropathy; catheter ablation

This page was created on 2021-07-06T14:10:16.911+09:00
This page was last modified on 2021-08-03T20:11:46.000+09:00


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