神奈川県立こども医療センター循環器内科Department of Cardiology, Kanagawa Children’s Medical Center
目的：冠動脈瘻（coronary arterial fistula: CAF）に対するカテーテル治療の長期的な予後を検討すること．
方法：対象は当院にてCAFに対してカテーテル治療を行った7例（年齢中央値1歳2か月）で，経過を後方視的に検討した．観察期間中央値は8年2か月（3か月～22年）．治療法について検討するとともに，残存短絡の有無と冠動脈の形態について冠動脈造影により評価した．
結果：CAFは遠位型4例，近位型3例であった．全例，冠動脈の末梢側に各種デバイスを留置しCAFを閉塞した．中央値1年2ヶ月後と5年7ヶ月後に冠動脈造影を施行し，全例CAFは完全閉塞し，血栓形成や閉塞も認めなかった．形態については，正常化4例，caliber change 2例，盲端1例であり，4例では，抗血小板剤や抗凝固薬の内服を継続している．
結論：CAFに対するカテーテル治療の長期予後は良好である．冠動脈拡張を残す症例や狭窄病変を認める症例には，抗血小板剤や抗凝固薬の内服の継続を行う必要がある．
Objectives: The purpose of this study was to examine the long-term prognosis of coronary arterial fistula (CAF) treated by catheter intervention.
Method: Seven patients (median age 1.1 year) were enrolled who underwent catheter treatment for CAF in our institution. All cases were examined retrospectively. The median observational period was 8.1 years (minimum 3 months, maximum 22 years). Residual shunt and coronary morphology were examined by the selective coronary angiography.
Results: All patients achieved complete occlusion of CAFs. Follow-up coronary angiography showed no thrombus, nor obstruction. The morphology of coronary artery was normalized in 4 cases, revealed caliber change in 2 and blind pouch in one. Antiplatelet or anticoagulant were continued in 4 patients. The CAF was classified as distal types in 4 and proximal types in 3, and all cases were closed with various devices in the distal portion. Follow-up coronary angiography was performed in each after median 1.1 year and 5.5 years, and neither residual shunt, nor thrombus nor obstruction was recognized.
Conclusions: The long-term prognosis of catheter treatment for CAF is good. Follow-up catheterization is mandatory, and in cases where coronary artery dilatation remains or where stenosis is confirmed, the oral administration of antiplatelet agents and anticoagulants are required
Key words: Coronary artery fistula; transcatheter closure; Amplatzer Vascular Plug; antiplatelet agent; anticoagulant
© 2019 日本Congenital Interventional Cardiology学会© 2019 Japanese Society of Congenital Interventional Cardiology
This page was created on 2020-02-18T09:47:38.761+09:00
This page was last modified on 2020-03-31T10:46:48.000+09:00
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