心房中隔欠損のカテーテル治療Transcatheter Device Closure of Atrial Septal Defects
静岡県立こども病院 循環器科Department of Cardiology, Shizuoka Children’s Hospital ◇ Shizuoka, Japan
経皮的心房中隔欠損閉鎖術が国内で始まり,約20年を迎えようとしている.現在では,開胸のいらない低侵襲な治療法として,幼児から高齢者まで幅広い年代で標準治療として施行されている.対象は,二次孔型の心房中隔欠損であり,一次孔型,静脈洞型,冠静脈洞型は適応外である.また二次孔型でも欠損孔の位置や大きさによっては対象外となるため,経食道を含めたエコーでの詳細な診断が重要になる.現在,国内では3種類のデバイスが使用可能で,その特徴を十分理解したうえで,重大な合併症となる心侵食や脱落に十二分な注意を払い治療にあたる必要がある.
In Japan, percutaneous atrial septal defect (ASD) closure has been conducted for approximately 20 years. Percutaneous ASD closure has been established as a standard therapy for patients with ASD of various ages, from infants to older adults, because it is a less invasive procedure without sternotomy. It is not recommended for patients with primum, sinus venosus, and coronary sinus type ASDs but for those with ostium secundum ASD. Detailed anatomical assessments of a defect by transesophageal echocardiography are crucial for deciding the indication of percutaneous ASD closure because the procedural success depends on the location and size of the defect. As three types of devices for ASD closure are currently available in Japan, fully understanding the characteristics and practices of these devices to prevent serious complications related to this procedure, including cardiac erosion and device embolization, is needed.
Key words: septal occluder; erosion; embolization
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