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 33(1): 69-75 (2017)
doi:10.9794/jspccs.33.69

症例報告Case Report

ECMO下にCT検査を施行した先天性心疾患小児3例の検討：有用性，安全性，限界についてComputed Tomography for Three Pediatric Patients with Congenital Heart Disease during Extracorporeal Membrane Oxygenation: Efficacy, Safety, and Limitations

中島 光一朗1，黒嵜 健一1，神崎 歩2，辻井 信之3，帆足 孝也4，鍵崎 康治4，市川 肇4，白石 公1Koichiro Nakashima1, Kenichi Kurosaki1, Suzu Kanzaki2, Nobuyuki Tsujii3, Takaya Hoashi4, Koji Kagisaki4, Hajime Ichikawa4, Isao Shiraishi1

1 国立循環器病研究センター小児循環器科Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center ◇ Osaka, Japan

2 国立循環器病研究センター放射線部Department of Radiology, National Cerebral and Cardiovascular Center ◇ Osaka, Japan

3 奈良県立医科大学附属病院小児科Department of Pediatrics, Nara Medical University Hospital ◇ Nara, Japan

4 国立循環器病研究センター小児心臓外科Department of Pediatric Cardiac Surgery, National Cerebral and Cardiovascular Center ◇ Osaka, Japan

受付日：2016年10月18日Received: October 18, 2016
受理日：2016年12月24日Accepted: December 24, 2016
発行日：2017年1月1日Published: January 1, 2017
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小児循環器領域において膜型人工心肺（ECMO）を使用する機会は増加している．そのため，治療方針決定にあたり詳細な解剖や血行動態評価が必要であり，診断手法としてマルチスライスCTの有用性は高い．

今回，ECMO管理下にCTを施行した先天性心疾患の小児3症例を経験した．

症例1：4か月女児．右側相同，右室性単心室，肺動脈狭窄，体肺動脈シャント手術後．シャント閉塞を来し緊急ECMO導入，肺血流再建治療の方針を決定するため造影CT検査を施行した．

症例2：1か月女児．右室性単心室，肺動脈狭窄，肺動脈スリング，気管低形成．呼吸不全となり気管内挿管されたが低酸素血症が改善せず緊急ECMO導入した．肺動脈スリング解除手術のために造影CT検査施行した．

症例3：5歳男児．修正大血管転位，ダブル・スイッチ手術後．間質性肺炎による呼吸不全のためECMO導入した．肺炎治療の効果判定およびECMO離脱方針決定のためECMO下でCT検査を施行した．

いずれも周到な準備と専門スタッフの支援のもとに安全に施行することができ，治療方針の決定に重要な情報を得られた．有用で安全なECMO下CT検査には，検査プロトコールの確立，専門医の確保，日常からの準備が大切である．

The use of extracorporeal membrane oxygenation (ECMO) is increasing in the field of pediatric cardiac diseases. Therefore, a detailed estimation of the anatomy and hemodynamics is necessary for determining the treatment strategy. Multi-detector row computed tomography (CT) is extremely beneficial as a diagnostic modality.

We performed CT examinations in three cases of pediatric congenital heart disease under ECMO support.

Case 1: A 4-month-old female presented with asplenia, right single ventricle, and pulmonary stenosis after pulmonary–systemic artery shunt surgery. The shunt became occluded; therefore, ECMO was introduced. Enhanced CT examination was performed before pulmonary blood flow reconstruction.

Case 2: A 1-month-old female presented with right single ventricle, pulmonary stenosis, pulmonary artery (PA) sling, and hypoplastic trachea. She had respiratory failure and was intubated. When her hypoxemia did not improve, ECMO was introduced and enhanced CT examination was performed before relief of the PA sling.

Case 3: A 5-year-old male presented with congenitally corrected transposition of the great artery after a double switch operation. He developed respiratory failure due to interstitial pneumonia; therefore, ECMO was introduced. Plain CT examination was performed to judge the effect of treatment and to determine the secession from ECMO.

Accurate preparation and support from specialists made the CT examination safe in every case, and we were able to obtain the information essential for determining the mode of treatment. For beneficial and safe CT examinations under ECMO, establishment of protocols, assurance from medical specialists, and proper preparation for the procedure are necessary.

Key words: multi-detector row CT; extracorporeal membrane oxygenation; pediatric congenital heart disease

© 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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This page was last modified on 2017-02-06T10:56:59.400+09:00

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