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): 243-248 (2022)

症例報告Case Report

Blalock–Taussigシャント術後に発症したStaphylococcus capitisによる感染性動脈瘤に対しハイブリッド手技を用いた外科的治療を行った1例Hybrid Procedure for Treating a Staphylococcus capitis-Induced Infectious Aneurysm after Blalock–Taussig Shunt Insertion: A Case Report

1日本赤十字社医療センター小児科Japanese Red Cross Medical center, Department of Pediatrics ◇ Tokyo, Japan

2日本赤十字社医療センター心臓血管外科Japanese Red Cross Medical center, Department of Cardiovascular Surgery ◇ Tokyo, Japan

3東京大学医学部附属病院小児科The University of Tokyo Hospital, Department of Pediatrics ◇ Tokyo, Japan

受付日:2022年4月16日Received: April 16, 2022
受理日:2022年8月4日Accepted: August 4, 2022
発行日:2022年12月1日Published: December 1, 2022

感染性動脈瘤はmodified Blalock–Taussig(mBT)シャント造設後に発症する稀な合併症である.致死的な経過を辿ることもあり迅速な治療が必要であるが画一した治療方法はない.今回mBTシャント術後に発症した感染性動脈瘤に対しカテーテル手技とのハイブリッド手技により安全に外科的治療を行えた症例を報告する.症例はファロー四徴症に対し左mBTシャント術後の5か月男児で,低酸素血症を主訴に来院し造影CT検査にてシャント位置に動脈瘤を認めた.また血液培養検査でStaphylococcus capitis陽性であり同菌による感染性動脈瘤が疑われた.抗生剤加療のみでは治療難渋し,感染巣の摘出が必要と考えた.胸骨正中切開の際に動脈瘤破裂や出血のリスクがあるため動脈瘤への流入血管でバルーン留置行い,完全に血流を遮断したうえで動脈瘤の摘出を行った.また同時に新規肺血流確保のため右室流出路再建を施行し術後56日に退院した.感染性動脈瘤に対するハイブリッド手技は補助治療として有力である.

Infectious aneurysms are rare complications of the modified Blalock–Taussig (mBT) shunt procedure. These aneurysms may have fatal outcomes and require prompt treatment; however, standardized treatment is lacking. This is a report of a successful case in which an infectious aneurysm that developed following mBT shunt placement was treated safely with a hybrid procedure involving catheterization. The patient was a 5-month-old boy who underwent left mBT shunt placement for tetralogy of Fallot. He subsequently presented with decreased oxygenation, and contrast-enhanced computed tomography revealed an aneurysm at the shunt insertion site. Blood culture was positive for Staphylococcus capitis, suggesting that the infectious aneurysm was caused by the bacterium. Antibiotic treatment alone was insufficient; and catheter removal of the infectious lesion was considered necessary. Due to the risk of rupture and aneurysmal bleeding during sternotomy, a blood vessel entering the aneurysm was obstructed using an indwelling balloon catheter. The aneurysm was removed after blood flow was completely blocked, and a right ventricular outflow tract repair was performed concomitantly to secure new pulmonary blood flow. The patient was discharged from the hospital 56 days postoperatively. This case demonstrates a promising adjunctive procedure for the treatment of infectious aneurysms.

Key words: infectious aneurysms; modified Blalock–Taussig shunt; Staphylococcus capitis; tetralogy of Fallot

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