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 38(1): 54-60 (2022)
doi:10.9794/jspccs.38.54

症例報告Case Report

極低出生体重児の大動脈縮窄症に対して経皮的大動脈バルーン拡張術後に外科治療を行った1例Successful Transcatheter Angioplasty Preceding Corrective Repair in an Extremely Low-Birth-Weight Infant with Coarctation of the Aorta

1産業医科大学小児科Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health ◇ Fukuoka, Japan

2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, Japan Community Healthcare Organization ◇ Fukuoka, Japan

3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Department of Cardiovascular Surgery, Kyushu Hospital, Japan Community Healthcare Organization ◇ Fukuoka, Japan

4地域医療機能推進機構九州病院病理科Department of Pathology, Kyushu Hospital, Japan Community Healthcare Organization ◇ Fukuoka, Japan

受付日:2021年8月3日Received: August 3, 2021
受理日:2021年12月23日Accepted: December 23, 2021
発行日:2022年2月1日Published: February 1, 2022
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大動脈縮窄症(COA)における乳児期の治療として外科治療もしくは経皮的バルーン拡張術(BA)が用いられる.特に低出生体重児の場合は,BAと外科治療のどちらであっても再狭窄率や合併症発症率が高いことが報告されている.症例は35週1,374 gで出生した女児,日齢6に収縮期血圧上下肢差64 mmHgを認めCOAと診断した.日齢25に最狭窄部1.3 mmのCOAに対し3 Frenchシースを使用して経動脈的にBAを実施した.冠動脈形成用バルーン(NC TREK®2 mm)で前拡張後に弁拡張用バルーン(TMP-PED®4 mm)で後拡張した.収縮期血圧較差9 mmHgまで改善した.BA後に体重増加が得られたが再狭窄が進行し,日齢108(体重3,050 g)に左側開胸で大動脈縮窄部切除と大動脈形成術を実施した.現在,生後7か月で再狭窄を認めていない.低出生体重児のCOAに対し,姑息的BA後に体重増加させ,外科治療を行うことは,合併症や予期せぬ再狭窄を予防できる点から有効であると考えられた.

For infants with coarctation of the aorta (COA), either transcatheter balloon angioplasty (BA) or surgical repair is used. COA recurs frequently in low-birth-weight infants who have had either BA or surgical repair. We present a case of a baby girl born at 35 weeks gestational age and weighing 1,374 g who underwent successful surgical repair of COA following palliative BA. A systemic blood pressure gradient of 64 mmHg between the upper and lower limbs was observed at the age of 6 days, confirming the diagnosis of COA. At the age of 25 days, we conducted BA for COA with a minimum diameter of 1.3 mm. Following the placement of a 3-French sheath in the femoral artery, we performed a predilatation with a coronary angioplasty balloon (NC TREK®2 mm) and a second dilatation with a valvuloplasty balloon (TMP-PED®4 mm). The systemic blood pressure difference between the upper and lower limbs was reduced to 9 mmHg after successful dilation. As a recurrence of COA developed along with body weight gain, coarctation resection and extended end-to-end anastomosis were performed at the age of 108 days and weight of 3,050 g. At the age of 7 months, there was no recurrence of COA. We believe that delayed surgical repair after palliative BA may be possible in low-birth-weight infants with COA to avoid recurrence of COA.

Key words: aortic coarctation; transcatheter balloon angioplasty; recurrence of aortic coarctation; extremely low-birth-weight infant; preterm infant

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This page was last modified on 2022-05-25T19:51:12.000+09:00


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