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 36(4): 306-310 (2020)
doi:10.9794/jspccs.36.306

原著Original

乳幼児期に無症状で発見されたsmall coronary arteriovenous fistula (CAVF）の中期経過Mid-Term Follow-Up of Asymptomatic Coronary Arteriovenous Fistulas in Children

三井 さやか1，福見 大地1，羽田野 爲夫2，大島 康徳3Sayaka Mii1, Daichi Fukumi1, Tameo Hatano2, Yasunori Ohshima3

1 名古屋第一赤十字病院小児循環器科Department of Pediatric Cardiology, Japanese Red Cross Nagoya Daiichi Hospital ◇ Aichi, Japan

2 愛知県三河青い鳥医療療育センターDepartment of Pediatrics, Mikawa Aoi tori Medical Nursing Center ◇ Aichi, Japan

3 あいち小児保健医療総合センターDepartment of Pediatric Cardiology, Aichi Children’s Health and Medical Center ◇ Aichi, Japan

受付日：2020年6月9日Received: June 9, 2020
受理日：2020年8月10日Accepted: August 10, 2020
発行日：2020年12月1日Published: December 1, 2020
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背景：近年エコーの精度向上によりsmall coronary arteriovenous fistula (CAVF）の指摘が増えているが自然経過の報告は少ない．

方法：2009年1月～2019年12月心エコーでCAVFを指摘された18歳以下の児の初診時月齢，性別，転帰，冠動脈走行等を診療録から後方視的に検討した．

結果：65名（男児34名，女児31名）が対象．初診時月齢中央値は4か月（0～86）で平均追跡期間は42か月（0～215）．当該期間に31名，48％に自然閉鎖を認めた．閉鎖率に男女差はないが，起始が左/右冠動脈では右冠動脈の，開口部が肺動脈内/心室内では心室内の閉鎖率が高かった（p＜0.05）．治療例は1例で1歳4か月時コイル塞栓を施行された．経過中虚血や心不全を認めた症例はなかった．

結論：CAVFの自然閉鎖は48％にみられた．右冠動脈起始あるいは開口部が心室内では早期の閉鎖率が高く，起始や流入部位による違いは経過をフォローする上で有用である．

Background: Recently, improvements in echocardiography techniques have increased the diagnosis of small asymptomatic coronary arteriovenous fistula (CAVF). However, the natural history and incidence of spontaneous closure are unknown.

Methods: We retrospectively analyzed all patients aged under 18 years with CAVF diagnosed via transthoracic two-dimensional doppler echocardiography between 2009 and 2019.

Results: In total, 65 (34 boys) children were diagnosed with CAVF and were enrolled in the analysis. The median age at diagnosis was 4 (0–86) months, and the mean follow-up period was 42 (0–215) months. Spontaneous closure of CAVF was observed in 31 (48％) children. There was no significant difference in terms of closure rate according to gender. Meanwhile, the left and right coronary arteries remarkably differed in terms of CAVF patency according to origin (p＜0.05). Moreover, there was a significant difference between the pulmonary artery and the ventricle in terms of CAVF patency according to drainage (p＜0.05). One patient underwent coil embolization at the age of 1 year and 4 months. However, no other intervention was required. None of the patients had ischemia or heart failure during the clinical course.

Conclusion: Approximately 48％ of patients experienced spontaneous closure of CAVF. The closure rate was higher than that previously reported, and it differed based on origin and opening of the fistula. Hence, assessment of the origin and opening of the fistula may be useful during follow-up.

Key words: small; coronary arteriovenous fistula; spontaneous closure; asymptomatic; children

© 2020 特定非営利活動法人日本小児循環器学会© 2020 Japanese Society of Pediatric Cardiology and Cardiac Surgery

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