1 静岡県立こども病院 循環器科Department of Cardiology, Shizuoka Children’s Hospital ◇ Shizuoka, Japan
2 静岡県立こども病院 心臓血管外科Department of Cardiovascular Surgery, Shizuoka Children’s Hospital ◇ Shizuoka, Japan
肺静脈閉塞を合併した総肺静脈還流異常では出生後早期の治療介入が求められる．我々は，肺静脈閉塞を伴う総肺静脈還流異常の早産極低出生体重児に対して，ステント留置と再拡張を先行し，待機的な開心術により合併症なく救命された1例を経験した．症例は在胎32週5日，体重1,284 gで出生し，肺静脈閉塞を伴う下心臓型総肺静脈還流異常と診断された．日齢4，狭窄部位である垂直静脈から静脈管にかけてステントを留置した．ステント内狭窄を生じたため，日齢29，日齢38にステント再拡張を行った．日齢57，1,849 gでsutureless法による心内修復術を施行し，合併症なく自宅退院した．
Patients with total anomalous pulmonary venous connection accompanying pulmonary venous obstruction require early interventions soon after birth. We experienced the case of a preterm baby with infracardiac total anomalous pulmonary venous connection and an obstructive vertical vein who underwent preemptive stent implantation and repetitive stent dilatation followed by elective corrective surgery. The patient was delivered at 32 weeks and 5 days of gestation and birth weight 1,284 g. Systemic oxygen saturation was 86％, and a chest X-ray showed pulmonary congestion. At the age of 4 days, a stent was placed at the obstructive ductus venosus, which required transcatheter stent dilatation due to in-stent stenosis at the age of 29 and 38 days. At last, intracardiac repair was performed with weight of 1,849 g at the age of 57 days. Stent implantation for an obstructive vertical vein is feasible and effective even in preterm or low birth weight infants with total anomalous pulmonary venous connection and an obstructive vertical vein.
Key words: congenital heart defect; cardiac catheterization; palliative treatment; total anomalous pulmonary venous return; stent implantation
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