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 40(2): 132-137 (2024)
doi:10.9794/jspccs.40.132

症例報告Case Report

窒息死に至った重複大動脈弓を合併したPrader–Willi症候群の一例Prader–Willi Syndrome and Double Aortic Arch: A High Risk for Critical Airway Obstruction

1東京北医療センター 小児科Department of Pediatrics, Tokyo-Kita Medical Center ◇ Tokyo, Japan

2榊原記念病院 小児循環器科Department of Pediatrics Cardiology, Sakakibara Heart Institute ◇ Tokyo, Japan

3東京医科歯科大学病院 小児科Department of Pediatrics, Tokyo Medical and Dental University Hospital ◇ Tokyo, Japan

4獨協医科大学埼玉医療センター 小児科Department of Pediatrics, Dokkyo Medical University Saitama Medical Center ◇ Saitama, Japan

受付日:2023年12月27日Received: December 27, 2023
受理日:2024年3月19日Accepted: March 19, 2024
発行日:2024年5月31日Published: May 31, 2024
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重複大動脈弓(double aortic arch: DAA)は血管輪を来す代表的な疾患である.一方Prader–Willi症候群(PWS)は先天異常症候群の一つで,特に新生児期から乳児期は筋緊張低下による哺乳障害や,時に呼吸障害を起こすことがある.これまでPWSにDAAを合併した症例報告はない.症例は他院でPWSと診断されフォローされていた.1歳6カ月時に吸気性喘鳴を認め当院の救急受診し,精査でDAAと診断した.軽度の吸気性喘鳴のみで酸素化不良や努力様呼吸は認めず待機手術の方針として退院したが,退院後17日目に自宅で食事中に誤嚥による窒息で死亡した.本症例ではPWSに伴う筋緊張低下や呼吸障害がDAAの診断を困難にし,さらに症状の増悪を惹起したと考えられた.筋緊張低下や嚥下障害のリスクの高い基礎疾患を有する症例に血管輪を合併した場合には,厳重な管理のもと速やかに治療を行うことが肝要である.

Double aortic arch (DAA) is a common condition resulting in vascular ring formation. Prader–Willi syndrome (PWS) is a congenital malformation that causes feeding difficulties due to hypotonia, particularly in the neonatal to infancy period, and can sometimes lead to respiratory problems. Currently, there are no documented cases of PWS accompanied by DAA. Our patient was a girl diagnosed with PWS who was being monitored at another hospital. When the patient was 1 year and 6 months old, she was rushed to our hospital because of inspiratory stridor. After further examination, she was diagnosed as DAA. Although she had residual mild inspiratory stridor, no hypoxemia or difficulty in breathing forcefully was noted. Therefore, she was discharged and planned for elective surgery. Unfortunately, 17 days after discharge, she died while eating at home. In this case, hypotonia and respiratory problems associated with PWS made the diagnosis of DAA challenging and led to worsening of symptoms. Therefore, in patients with vascular rings who present with hypotonia and dysphagia, immediate diagnosis and treatment are essential.

Key words: Prader–Willi syndrome; double aortic arch; critical airway obstruction

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This page was last modified on 2024-09-09T13:19:35.000+09:00


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