1 宮城県立こども病院集中治療科Miyagi Children’s Hospital, Department of Intensive Care ◇ Miyagi, Japan
2 静岡県立こども病院循環器科Shizuoka Children’s Hospital, Pediatric Cardiology ◇ Shizuoka, Japan
背景：本研究の目的は小児期の無症候性大動脈弁閉鎖不全（asymptomatic aortic regurgitation: aAR）に対する至適な外科治療のタイミングについて左室予備能の観点から検討することである．
方法：静岡県立こども病院で外科治療を行った18歳以下のaAR33例を対象に診療録と心エコー画像を用いて後方視的に検討した．
結果：術前の心エコーにおいて左室収縮末期径係数（indexed end-systolic dimension: ESDI）が31 mm/m2未満または左室拡張末期径係数（indexed end-systolic dimension: ESDI）が51 mm/m2未満のaAR患者では，外科治療により各々80％（12/15）および77％（13/17）において術後3年間で左室容積が正常範囲（ESDI ＜25 mm/m2かつEDDI ＜40 mm/m2）へ改善した．なお，これらの群では全例が術前の左室駆出率（ejection fraction: EF）≧50 ％であった．術後に左室容積やEFの正常化を認めないハザード比は術前ESDI ≧31 mm/m2: 1.60（95％信頼区間0.6–4.3, p＝0.3），EDDI ≧51 mm/m2: 1.75（95％信頼区間0.6–5.2, p＝0.3），術前EF ＜50％: 3.37（95％信頼区間0.8–14.6, p＝0.1）であった．観察期間中の死亡や大動脈弁に対する再手術は認めなかった．
結論：ESDI ≧31 mm/m2やEDDI ≧51 mm/m2は18歳以下のaARに対する外科的介入時期を決定する上で有用な指標になりうる．
Background: Surgical intervention for asymptomatic aortic regurgitation (aAR) should be performed while the left ventricular (LV) functional reserve is maintained. However, data on the optimal timing for surgery in pediatric patients with aAR are scarce. Therefore, this study aimed to clarify the optimal timing for surgical intervention in patients with aAR in consideration of the LV functional reserve.
Methods: Thirty-three patients with aAR who were ＜18 years old and underwent aortic valve repair at Shizuoka Children’s Hospital were enrolled. We retrospectively examined their medical charts and echocardiography records.
Results: For patients in whom the preoperative echocardiographic assessment of LV geometry showed either an indexed left ventricular end-systolic dimension (ESDI) of ＜31 mm/m2 or an indexed end-diastolic dimension (EDDI) of ＜51 mm/m2, LV dimension improved to the normal range (ESDI ＜25 mm/m2 and EDDI ＜40 mm/m2) at 3 years after surgery while maintaining an LV ejection fraction (EF) of ≥50％ in 80％ and 77％ of the patients, respectively. Hazard ratios for not recovering to the normal LV geometry or EF after the surgery were as follows: preoperative ESDI ≥31 mm/m2: 1.60 (95％ confident interval [CI]: 0.6–4.3, p＝0.3), preoperative EDDI ≥51 mm/m2: 1.96 (95％ CI: 0.6–5.2, p＝0.3), preoperative EF ＜50％: 3.37 (95％ CI: 0.8–14.6, p＝0.1). Death and aortic valve reoperation were not noted during the observation period.
Conclusion: An ESDI of ≥31 mm/m2 or EDDI ≥51 mm/m2 can be useful indicators for determining the optimal timing for surgical intervention in patients with aAR who are younger than 18 years.
Key words: asymptomatic aortic regurgitation; indexed end-systolic dimension; indexed end-diastolic dimension
© 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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This page was last modified on 2020-04-24T14:53:34.000+09:00
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