福岡市立こども病院循環器科Department of Cardiology, Fukuoka Children’s Hospital ◇ Fukuoka, Japan
背景：単心室疾患群では，体肺動脈側副血管（APCA）の増加がFontan術後の合併症につながるため，術前にコイル塞栓を行うことがある．その目標については術後のAPCAの推移も考慮することが必要である．
方法： 2009年から2015年に当院でFontan手術を行った連続163人を対象とした．APCAの発達の程度を，心カテでの大動脈造影から3段階に点数化し，左右内胸動脈，左右鎖骨下動脈，下行大動脈の5か所のscoreの総和（0～10点）を算出，Fontan術前後にコイル塞栓群，非塞栓群比較した．
結果：術後6か月時点でAPCA scoreの平均はコイル施行群：6.1±1.5→4.5±1.8点，非塞栓群：4.4±1.7点→3.6±1.7点と有意に減少していた．術後5年以上で評価した35例では，scoreは全例で術後6か月時に比し減少していた．Fontan術前後でMRIを施行した30例において，APCA flowの平均は術前1.4±0.6 L/min→術後0.8±0.6 L/minと減少しており，同様の傾向であった．Fontan術前のscoreが5点以下の症例では塞栓群，非塞栓群の間で胸水貯留が遷延した症例の割合に差を認めなかった．
結論：Fontan術後は，コイル塞栓の有無にかかわらずAPCAが減少する傾向にあった．術前のコイル塞栓はルーチンで行う必要はなく，score 6点以上が適応と考えられる．
Background: In patients with a functional single-ventricle, coil embolization is commonly performed to avoid complications after the Fontan procedure. The position for coil embolization should be determined after considering the postoperative changes in the aortopulmonary collateral arteries (APCAs).
Methods: The study involved 163 patients who underwent the Fontan procedure between 2009 and 2015. The amount of APCA was assessed using a 3-point scale based on the aortogram in the cardiac catheterization. The total score for the five sites (bilateral internal thoracic artery, bilateral subclavian artery, and descending aorta) was calculated and compared in patients with and without coil embolization and before and after the Fontan procedure.
Results: The mean scores for the APCAs ranged from 6.1±1.5 to 4.5±1.8 points in patients with coil embolization (＋) and from 4.4±1.7 to 3.6±1.7 points in those without coil embolization (−), indicating a significant decrease. The scores of 35 patients at ≥5 years after the Fontan procedure had decreased as compared to those at 6 months postoperatively (mean 4.2±2.0 to 1.3±1.2 points). The APCA flow of 30 patients measured using a magnetic resonance imaging similarly decreased after the Fontan procedure (mean 1.4±0.6 to 0.8±0.6 L/min). When APCA scores before the Fontan procedure were ≤5 points, there were no significant differences between the coil embolization (＋) and coil embolization (−) groups as to the incidence of prolonged pleural effusion.
Conclusion: After the Fontan procedure, the APCA tended to decrease with or without coil embolization. Routine coil embolization is not necessary, which is indicated only when APCA scores are ≥6 points.
Key words: aorto pulmonary collateral artery; Fontan procedure; coil embolization; single ventricle; bidirectional Glenn procedure
© 2018 特定非営利活動法人日本小児循環器学会© 2018 Japanese Society of Pediatric Cardiology and Cardiac Surgery
This page was created on 2018-12-03T15:58:11.976+09:00
This page was last modified on 2018-12-25T09:36:18.000+09:00
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