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 38(4): 234-242 (2022)


本邦における胎児先天性心疾患への出生前治療介入について:より良い出生後治療につなげるためにPrenatal Intervention for Fetal Congenital Heart Diseases in Japan: A Bridge Leading to Better Postnatal Prognosis

大阪母子医療センター小児循環器科Department of Cardiology, Osaka Women’s and Children’s Hospital ◇ Osaka, Japan

発行日:2022年12月1日Published: December 1, 2022

近年,胎児のエコースクリーニング検査が浸透し,多くの先天性疾患が出生前に診断されている.そのなかで,胎児期に心不全から胎児死亡に進行するものや,先天性心疾患(congenital heart disease: CHD)重症度が妊娠経過中に進行し,生後治療では救命が困難となる重症CHDが存在することが明らかになっている.これらの疾患に対して様々な出生前治療介入が,欧米を中心として施行されており,治療方法や治療成績,予後改善効果について報告されている.本邦でも致死的な胎児CHDに対する胎児治療の臨床研究や臨床試験が行われており,胎児頻脈/徐脈性不整脈,重症大動脈弁狭窄に対して,母体・胎児の安全性を担保しながら一歩ずつ着実に施行可能になっている.一方でCircular shuntを伴うエプスタイン病に対する非ステロイド性抗炎症薬投与に関しては,国内ではまだ報告がなく,これから進められる介入と考えられる.いずれの治療介入についても母体・胎児に関する倫理的課題や診療制度構築の問題があり,それらに対して同時に取り組んでいく必要がある.種々の問題に対処しながら,世界の胎児心臓治療水準に並べるようにしていくことが望まれている.

In recent years, fetal ultrasound screening has become widespread, leading to most congenital diseases being diagnosed prenatally. Nonetheless, some cases still progress to fetal heart failure leading to fetal death during their uterine period, while others with congenital heart disease (CHD) still experience severe deterioration, making survival difficult even with intensive postnatal therapy. Various prenatal interventions for these diseases have been implemented mainly in Europe and the United States, and there are many reports concerning their outcomes and effects on prognostic improvement. In Japan, clinical studies and trials on fetal interventions for severe CHD (e.g., treatments for fetal arrhythmias and severe aortic valve stenosis) have continued to be conducted and steadily implemented. Conversely, there have yet been no reports in Japan on the administration of nonsteroidal anti-inflammatory drugs for Ebstein disease with circular shunt, which can advance in the near future. There are ethical issues surrounding maternal and fetal health and the medical insurance system that need to be addressed through multidisciplinary collaboration. Nonetheless, we expect our fetal cardiac interventions and therapies to be able to match international standards.

Key words: congenital heart disease; prenatal diagnosis; fetal cardiac intervention; transplacental pharmacotherapy

This page was created on 2023-01-16T09:33:25.709+09:00
This page was last modified on 2023-02-21T17:43:05.000+09:00