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
Pediatric Cardiology and Cardiac Surgery 31(3): 111-116 (2015)


2.5 kg以下の新生児・乳児における体外循環非使用肺動脈絞扼術の転帰と問題点Outcome of Pulmonary Artery Banding without Cardiopulmonary Bypass in Infants Weighing Less than 2.5 kg

筑波大学附属病院心臓血管外科Department of Cardiovascular Surgery, University of Tsukuba Hospital ◇ 〒305-8576 茨城県つくば市天久保二丁目1番1号2-1-1 Amakubo, Tsukuba-shi, Ibaraki 305-8576, Japan

受付日:2013年12月16日Received: December 16, 2013
受理日:2015年4月1日Accepted: April 1, 2015
発行日:2015年5月1日Published: May 1, 2015

背景:先天性心疾患を有する低体重児において内科的治療の継続が困難な場合,体外循環を使用しない姑息術が選択されることが少なくない.しかしながら,低体重児の体外循環非使用姑息術の適応や手技について定まった指針はない.過去10年間の2.5 kg以下の低体重児に対する姑息術を振り返り,肺動脈絞扼術(PAB)の調節方法を再確認し,その経過と転帰とを検証した.

方法:2003年11月から2013年7月までに,初回手術として体外循環を使用せずにPABを行った体重2.5 kg以下の先天性心疾患11例(日齢6~78,体重1.1~2.5 kg)を対象として後方視的調査を行った.主肺動脈絞扼術(main PAB)9例,分枝肺動脈絞扼術(branch PAB)2例であった.

結果:1例が非心臓死した.生存10例中9例が平均体重4.6 kgで第二期手術に到達し,8例が最終修復を完了した.main PABの1例で心室容量負荷を来した.main PAB時の平均肺体動脈血圧比(Pp/Ps)は0.54,絞扼周径は体重(kg)+18.2 mmで概ねTruslerの基準以下であった.計3枝のbranch PABの平均周径は体重(kg)+8.0 mmであった.


Background: Congenital heart defects have been an important cause for death among low birth weight (LBW) infants. Corrective surgery is not always a favorable solution for these fragile babies, and surgeons may choose palliative surgery, which is technically demanding. We reviewed our 10 years of experience and the outcome of initial pulmonary artery banding (PAB) without cardiopulmonary bypass (CPB) in LBW infants.

Patients and methods: Eleven infants (age, 6~78 days; body weight, 1.1~2.5 kg) underwent initial PAB without CPB (9 cases of main PAB and 2 cases of branch PAB).

Results: One patient died from a non-cardiac event. Nine patients successfully underwent the second-stage operation, at a mean weight of 4.6 kg, and eight completed the final stage. One patient experienced ventricular volume overload after main PAB. The mean Pp/Ps (pulmonary systemic blood pressure ratio) was 0.54 and the circumference of the band for the main PAB was body weight (kg)+18.2 mm, which was a little tighter than Trusler’s rule. The circumference for the branch PAB was body weight (kg)+8.0 mm. Of the patients who weighed less than 2 kg, all five gained body weight, and four of them successfully reached the final stage.

Conclusion: PAB in LBW infants resulted in fair clinical outcomes with acceptable morbidity and mortality. However, there is a need for specific guidance, based on accumulated experience, for the procedure and management.

Key words: low weigth infant; palliative cardiac repair without cardiopulmonary bypass; Trusler’s formula; pulmonary artery banding

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