冠動脈移植手術（coronary transfer）を要する小児期手術後の冠動脈狭窄や閉塞は稀であるが，重篤な合併症で手術死・遠隔死の重要な原因となる．この早期発見と早急な対処は手術成績，遠隔期成績の改善に通じる．この合併症は新生児期に行う大血管転位症に対する動脈スイッチ手術（arterial switch operation: ASO）において特に重要である．低体重で，かつ冠動脈の異常が少なくないからである．この合併症に対して2つの手術法が存在するが，その適応基準は定められていない．1つは外科的冠動脈口パッチ形成術（surgical ostial angioplasty: SOAP），他は内胸動脈グラフトを用いた小児冠動脈バイパス法である（pediatric coronary artery bypass surgery with an internal thoracic artery graft: PCABS-ITA）．両法にはそれぞれ利点と欠点があるが，早期成績には両者の差は明らかでない．現状では病変の重症度と範囲に鑑みながら，急性期の緊急救命手術にはSOAPがI（C），PCABS-ITAがIIa（C），ASO術後遠隔期の冠閉塞には，新大動脈の拡張や弁閉鎖不全，右室流出路狭窄等がなければPCABS-ITAがI（C），SOAPがIIa（C）と考えている．今後，遠隔成績の追跡が重要となる．幸い稀な合併症であるため，databaseによる遠隔成績の解析が必須である．
需要进行冠状动脉移植手术(coronary transfer)的儿童期手术后冠状动脉狭窄或闭塞非常罕见，但这是严重的并发症，是导致手术死亡和远程死亡的重要原因。这种早期发现和及时处理可以改善手术成绩，远程期成绩。这种合并症在新生儿期进行的动脉开关手术(arterial switch operation, ASO)中尤为重要。因为体重低，而且有不少冠状动脉异常。针对该并发症存在两种手术方法，但尚未确定其适应标准。一个是外科冠状动脉口贴片成形术(surgical ostial angioplasty)SOAP)，另一种是采用胸内动脉移植的儿童冠状动脉搭桥法(pediatric coronary artery bypass surgery with an internal thoracicartery graft: PCABS-ITA)。两法各有利弊，但早期成绩差别不大。目前鉴于病变的严重程度和范围，急性期紧急救命手术SOAP使用I (C)， pcbs - ita使用IIa (C)， ASO术后远程期冠状闭塞使用新主动脉扩张和瓣膜闭合不全;如果没有右室流出通道狭窄等，则pcbs - ita为I (C)， SOAP为IIa (C)。今后，远程成绩追踪将变得十分重要。幸好这是罕见的并发症，必须通过database解析远程成绩。
{"title":"Coronary Obstructive Complication Following Coronary Transfer Procedures for Congenital Heart Disease: Evaluation of Surgical Managements and Proposal for Guidelines","authors":"Soichiro Kitamura","doi":"10.9794/jspccs.39.3","DOIUrl":"https://doi.org/10.9794/jspccs.39.3","url":null,"abstract":"冠動脈移植手術（coronary transfer）を要する小児期手術後の冠動脈狭窄や閉塞は稀であるが，重篤な合併症で手術死・遠隔死の重要な原因となる．この早期発見と早急な対処は手術成績，遠隔期成績の改善に通じる．この合併症は新生児期に行う大血管転位症に対する動脈スイッチ手術（arterial switch operation: ASO）において特に重要である．低体重で，かつ冠動脈の異常が少なくないからである．この合併症に対して2つの手術法が存在するが，その適応基準は定められていない．1つは外科的冠動脈口パッチ形成術（surgical ostial angioplasty: SOAP），他は内胸動脈グラフトを用いた小児冠動脈バイパス法である（pediatric coronary artery bypass surgery with an internal thoracic artery graft: PCABS-ITA）．両法にはそれぞれ利点と欠点があるが，早期成績には両者の差は明らかでない．現状では病変の重症度と範囲に鑑みながら，急性期の緊急救命手術にはSOAPがI（C），PCABS-ITAがIIa（C），ASO術後遠隔期の冠閉塞には，新大動脈の拡張や弁閉鎖不全，右室流出路狭窄等がなければPCABS-ITAがI（C），SOAPがIIa（C）と考えている．今後，遠隔成績の追跡が重要となる．幸い稀な合併症であるため，databaseによる遠隔成績の解析が必須である．","PeriodicalId":19794,"journal":{"name":"Pediatric Cardiology and Cardiac Surgery","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135202200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Satoshi Matsuo, Kota Itagaki, Masayuki Otani, Yusuke Suzuki, Shintaro Katahira, Takehiko Onoki, Chiharu Ota, Shinya Iwasawa, Yoshikatsu Saiki
症例は12歳の男児で，出生後，大動脈縮窄症，心室中隔欠損症と診断され，生後1か月時に左側開胸にて拡大大動脈弓吻合法による手術が施行された．術後再狭窄を認め，バルーン血管形成術を5か月，3歳時に施行された．11歳時の精査で全長4 cmにわたる最小径5 mm, 圧較差50 mmHgに狭窄が進行した．また，大動脈弁逆流の進行も認めた．再手術に伴う大動脈周囲の高度な癒着，選択的脳分離体外循環の確立，大動脈弁閉鎖不全症と心室中隔欠損に対する外科的治療，これらの要素から胸骨正中切開と左前側方開胸を用いた下行大動脈人工血管置換，大動脈弁置換，心室中隔欠損閉鎖術を施行した．術後の上下肢圧較差は消失した．胸骨正中切開および左開胸アプローチは手術侵襲が大きいものの，安全に選択的脳分離体外循環を確立でき，解剖学的修復という観点から大動脈縮窄の根治性が高く，また心内修復も併施可能な手法である．
Kimihiro Yoshii, Jun Sato, Atsuko Kato, S. Yoshida, S. Takeda, H. Nisikawa, T. Osawa, T. Sakurai, T. Nonaka, H. Sakurai, N. Ohashi
We describe a male infant who was diagnosed in utero with pulmonary atresia and an intact ventricular septum (PA-IVS) and diagnosed with aortocoronary atresia (ACA) by cardiac catheterization after birth. He was deliv-ered at full term and appeared normal for gestational age. Electrocardiography findings on day 3 of life showed ST depression while crying, and right ventricle-dependent coronary circulation (RVDCC) was suspected. Cardiac catheterization findings confirmed PA-IVS and ACA. We evaluated the blood flow of sinusoidal communication (SC) during the clinical course using pulsed-wave Doppler echocardiography. He underwent a Blalock ‒ Taussig shunt and an ascending aorta-to-right ventricle shunt (Ao-RV shunt) on day 41 of life. At the time of delivery, SC flow was antegrade from the right ventricle (RV) to the intramyocardium at systole and retrograde from the intramyocardium to the RV at diastole. Antegrade SC flow became biphasic after the Ao-RV shunt and increased at end-diastole. Furthermore, the increased oxygenation of SC blood due to the Ao-RV shunt helped to improve the coronary circulation. This novel Ao-RV shunt approach is suitable for treating PA-IVS and ACA.
{"title":"New Aorta-To-Right Ventricle Shunt Strategy for Pulmonary Atresia with Intact Ventricular Septum and Aortocoronary Atresia: Evaluation by Monitoring Sinusoidal Communication Flow","authors":"Kimihiro Yoshii, Jun Sato, Atsuko Kato, S. Yoshida, S. Takeda, H. Nisikawa, T. Osawa, T. Sakurai, T. Nonaka, H. Sakurai, N. Ohashi","doi":"10.9794/jspccs.36.72","DOIUrl":"https://doi.org/10.9794/jspccs.36.72","url":null,"abstract":"We describe a male infant who was diagnosed in utero with pulmonary atresia and an intact ventricular septum (PA-IVS) and diagnosed with aortocoronary atresia (ACA) by cardiac catheterization after birth. He was deliv-ered at full term and appeared normal for gestational age. Electrocardiography findings on day 3 of life showed ST depression while crying, and right ventricle-dependent coronary circulation (RVDCC) was suspected. Cardiac catheterization findings confirmed PA-IVS and ACA. We evaluated the blood flow of sinusoidal communication (SC) during the clinical course using pulsed-wave Doppler echocardiography. He underwent a Blalock ‒ Taussig shunt and an ascending aorta-to-right ventricle shunt (Ao-RV shunt) on day 41 of life. At the time of delivery, SC flow was antegrade from the right ventricle (RV) to the intramyocardium at systole and retrograde from the intramyocardium to the RV at diastole. Antegrade SC flow became biphasic after the Ao-RV shunt and increased at end-diastole. Furthermore, the increased oxygenation of SC blood due to the Ao-RV shunt helped to improve the coronary circulation. This novel Ao-RV shunt approach is suitable for treating PA-IVS and ACA.","PeriodicalId":19794,"journal":{"name":"Pediatric Cardiology and Cardiac Surgery","volume":"27 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141226609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：