静岡県立こども病院循環器科Department of Cardiology, Shizuoka Children’s Hospital ◇ Shizuoka, Japan
背景：単心室疾患の治療成績が上昇し，Fontan患者は年々増加している．しかし，Fontan術後に不整脈やfailing Fontan状態などの様々な遠隔期合併症に苦しむ患者も多い．このような問題に対するカテーテル治療として，Fontan導管への経皮的穿刺・開窓術（transcatheter puncture and fenestration: TPF）を行うことがあるが，その効果・合併症についての報告は少ない．
方法：当院にてTPFを行った7症例（9件）を対象として，カテーテル治療の効果・合併症について後方視的に検討した．
結果：全9件のカテーテル治療の適応の内訳は，不整脈が4症例（5件），鋳型気管支炎（plastic bronchitis: PB）が3症例（3件），蛋白漏出性胃腸症（protein-losing enteropathy: PLE）が1症例（1件）であった．PBとPLEの症例は開窓部分にステント留置を行い，3/4件で静脈圧が低下した．不整脈に対するアブレーションは5/5件で成功した．総カテーテル時間（中央値）は243分（194～420分）と長時間であった．
結論：TPFは開心術を要さずに，Fontan術後の問題を解決しうる治療方法であり，Fontan患者の予後改善に寄与する可能性がある．
Background: With improved treatment of single ventricle physiology, Fontan-type repaired cases are continuously increasing. After Fontan procedures, patients may have severe complications such as supraventricular tachyarrhythmia or failing Fontan circulation. Trans-catheter puncture and fenestration (TPF) to the Fontan conduit have been used as a catheter treatment to address these complications. Due to the technical challenges of the procedures, there are few reports on the effects of trans-catheter re-interventions and the possible complications.
Methods: We retrospectively reviewed the effects and complications of TPF in 7 cases (a total of 9 procedures) performed from 2010 to 2019 in our hospital.
Results: The indications for catheter treatment were: (1) supraventricular tachyarrhythmia (n=4, with 5 procedures); (2) plastic bronchitis (PB) (n=3); and (3) protein-losing gastroenteropathy (PLE) (n=1). In cases of PB and PLE, stent implantation was added into the percutaneously created fenestration. In 3 out of 4 cases, a decrease in central venous pressure was confirmed. Ablation was successful with an efficient catheter approach in all cases. All 9 TPF procedures were completed without complications.
Conclusions: TPF is a feasible and safe therapeutic option compared to open-heart surgery. Additionally, it has a potential for improving specific complications after Fontan completion.
Key words: Fontan; fenestration; plastic bronchitis; protein-losing enteropathy; catheter ablation
© 2021 特定非営利活動法人日本小児循環器学会© 2021 Japanese Society of Pediatric Cardiology and Cardiac Surgery
This page was created on 2021-07-06T14:10:16.911+09:00
This page was last modified on 2021-08-03T20:11:46.000+09:00
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