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
Pediatric Cardiology and Cardiac Surgery 31(4): 184-189 (2015)
doi:10.9794/jspccs.31.184

原著Original

遠隔期成績からみた完全房室中隔欠損症に対する術式選択の検討Long-term Results of Complete Atrioventricular Septal Defect Compared Simplified Single-patch Method with Two-patch Method

石丸 和彦1，西垣 恭一1，金谷 知潤1，荒木 幹太1，中村 香絵2，佐々木 赳2，藤野 光洋2，平野 恭悠2，川崎 有希2，江原 英治2，吉田 修一朗3，吉田 葉子3，鈴木 嗣敏3，村上 洋介2Kazuhiko Ishimaru1, Kyoichi Nishigaki1, Tomomitsu Kanaya1, Kanta Araki1, Kae Nakamura2, Takeshi Sasaki2, Mitsuhiro Fujino2, Yasuhiro Hirano2, Yuki Kawasaki2, Eiji Ehara2, Syuichiro Yoshida3, Yoko Yoshida3, Tsugutoshi Suzuki3, Yosuke Murakami2

1 大阪市立総合医療センター小児医療センター小児心臓血管外科Department of Pediatric Cardiovascular Surgery, Pediatric Medical Care Center, Osaka City General Hospital ◇ 〒534-0021 大阪府大阪市都島区都島本通2丁目13番22号2-13-22 Miyakojima Hon-dori, Miyakojima-ku, Osaka-shi, Osaka 534-0021, Japan

2 大阪市立総合医療センター小児医療センター小児循環器内科Department of Pediatric Cardiology, Pediatric Medical Care Center, Osaka City General Hospital ◇ 〒534-0021 大阪府大阪市都島区都島本通2丁目13番22号2-13-22 Miyakojima Hon-dori, Miyakojima-ku, Osaka-shi, Osaka 534-0021, Japan

3 大阪市立総合医療センター小児医療センター小児不整脈科Department of Pediatric Electrophysiology, Pediatric Medical Care Center, Osaka City General Hospital ◇ 〒534-0021 大阪府大阪市都島区都島本通2丁目13番22号2-13-22 Miyakojima Hon-dori, Miyakojima-ku, Osaka-shi, Osaka 534-0021, Japan

受付日：2014年11月11日Received: November 11, 2014
受理日：2015年5月8日Accepted: May 8, 2015
発行日：2015年7月1日Published: July 1, 2015
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目的：完全型房室中隔欠損（cAVSD）に対する各術式の術後遠隔期成績ならびに術式選択について検討すること．

対象と方法：対象は，2000年1月から2012年12月の間に，当院で2心室修復術を施行したcAVSD 29例（21 trisomy 24例）．房室弁形態はRastelli type A 20例，type C 9例で，two-patch法を17例（T群），simplified single-patch法を12例（S群）に施行．各群における術前ならびに術中の患者因子ならびに術後心エコー検査による左側房室弁逆流（lt AVVR）を比較し評価した．

結果：S群はT群に比し，心室中隔欠損（VSD）の深さ（8.2±2.0 vs. 5.6±2.3 mm, p=0.001）は浅かった．術後10年でのlt AVVRに対する再手術回避率はT群76%，S群68%で有意差なし（p=0.931）．T群の再手術症例は，lt AVVRに対する弁形成術1例，弁置換術3例で，S群は，lt AVVRに対する弁形成術1例，弁置換術1例，左室流出路（LVOT）膜様狭窄解除術1例であった．またT群2例で術中simplified single-patch法からtwo-patch法へ移行し，1例はRastelli type AでVSDは7 mmと深く，simplified single-patch法施行後に共通前後尖が落ち込み，1例はtype CでVSDが前上方進展しており，simplified single-patch法施行後LVOTOを認めた．

結論：cAVSDに対する術後遠隔期成績は両術式とも差はなく，術式選択に関しては，弁尖形態，VSDの深さのみならずその進展方向も考慮すべきと考えられた．

Background: Left atrioventricular valve regurgitation (LAVVR) is the most frequent indication for reoperation following complete atrioventricular septal defect (c-AVSD) repair.

Methods: Between January 2000 and December 2012, 17 of 29 patients with c-AVSD underwent the two-patch method (T group), whereas the remaining 12 patients underwent the simplified single-patch method (S group). The preoperative parameters and LAVVR of these groups were evaluated and compared.

Results: Ventricular septal defect (VSD) depth was shallower in the S group than that in the T group, but no significant differences were evident between the groups in any of the other parameters. Actuarial freedom from reoperation for LAVVR at 10 years was 75% in the T group and 68% in the S group (p=0.93). Two cases in the T group were converted from the simplified single-patch method. One of these cases had a 7-mm VSD as measured from the crest of the VSD to the level of the common atrioventricular valve and a bi-bridging leaflet that was positioned at the crest of the VSD and that did not allow coaptation with the left mural leaflet after the simplified single-patch method. The other case had a free-floating superior bridging leaflet and anterosuperior extension of the VSD, and left ventricular outflow tract obstruction (LVOTO) appeared after the simplified single-patch method.

Conclusions: No differences were observed in the mid- to long-term results between these two methods. Not only the scoop depth but also the anterosuperior extension of the VSD should be considered when determining the operating method because this could lead to asymmetric configuration of the valve leaflet and LVOTO.

Key words: complete atrioventricular septal defect; simplified single-patch method; two-patch method

© 2015 特定非営利活動法人日本小児循環器学会© 2015 Japanese Society of Pediatric Cardiology and Cardiac Surgery

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This page was last modified on 2015-08-13T16:23:03.837+09:00

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