1 あかね会土谷総合病院小児科Department of Pediatrics, Tsuchiya General Hospital ◇ Hiroshima, Japan
2 あかね会土谷総合病院心臓血管外科Department of Cardiovascular Surgery, Tsuchiya General Hospital ◇ Hiroshima, Japan
背景：当院では乳幼児期に行う肺動脈閉鎖兼心室中隔欠損症（PA/VSD）の修復術において可能な限り後壁に自己組織を用いた右室流出路再建術（RVOTR）を施行している．
方法：対象は1996～2015年に3歳未満で修復術を行ったPA/VSD 18例．RVOTRにおいて後壁に自己組織を用いた12例（A群）とexpanded polytetrafluoroethylene導管を用いた6例（C群）に分けて再手術と再介入の回避率とその期間，術後肺動脈狭窄へのバルーン拡張術の効果について検討した．
結果：A群，C群の再手術回避率；5年72.7％，62.5％: 10年72.7％，0％，再介入回避率；1年63.6％，50.0％: 3年36.4％，16.7％であり，A群のほうが高い傾向を認めた［p＝0.35, 0.16，ハザード比0.47, 0.47］．バルーン拡張術はA群；10件12か所，C群；10件14か所で，右室圧／左室圧比の変化では有意差は認めなかったが，再手術のないA群の症例（6件8か所）では有意に低下していた［p＝0.001］．
結論：後壁に自己組織を使用するRVOTRは再手術時期を遅らせる可能性がある．
Background: We use autologous tissue (AT) for the posterior wall during repair of the right ventricular outflow tract (RVOTR) whenever possible during biventricular repair (BVR) in infants with pulmonary atresia with ventricular septal defect (PAVSD).
Methods: This study included 18 patients who underwent BVR for PAVSD by age 3 at our institute between 1996 and 2015. Patients were divided into groups of 12 and 6 who underwent RVOTR using AT as the posterior wall of the RVOT (Group A) and an expanded polytetrafluoroethylene conduit (Group C), respectively.
Results: Rates of freedom from reoperation and re-intervention tended to be higher in Group A than C (reoperation at 5 and 10 years, 72.7％ vs 62.5％ and 72.7％ vs 0％, respectively; re-intervention at 1 and 3 years, 63.6％ vs 50.0％ and 36.4％ vs 16.7％, respectively; p＝0.35 and p＝0.16, respectively; hazard ratio [HR], both 0.47). Postoperative pulmonary artery stenosis was treated by balloon dilation in Group A (10 times for 12 lesions) and Group C (10 times for 14 lesions). The ratio of right ventricular/left ventricular peak systolic pressure (RVP/LVP) did not significantly differ before and after treatment in both groups. The RVP/LVP significantly decreased among patients who did not undergo reoperation in Group A (6 times for 8 lesions; p＝0.001).
Conclusions: Applying RVOTR with AT as the posterior wall of the RVOT for BVR in infants with PAVSD may postpone the need for reoperation.
Key words: pulmonary atresia with ventricular septal defect; right ventricular outflow tract repair; reoperation; postoperative pulmonary stenosis; balloon dilatation
© 2017 特定非営利活動法人日本小児循環器学会© 2017 Japanese Society of Pediatric Cardiology and Cardiac Surgery
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