静岡県立こども病院 循環器科Department of Cardiology, Shizuoka Children’s Hospital
【背景】多孔性心房中隔欠損（multi-fenestrated atrial septal defect; MFASD）の類縁病変として1つの欠損孔が紐状構造物（strand）により，まれに2分割されることがあり，経皮的心房中隔欠損（atrial septal defect; ASD）閉鎖術の際に手技上の特別な配慮が必要となる．閉鎖術の際にstrandを支持力のある辺縁の一部として利用できる可能性とその効果について検討した．
【方法】当院で経験したASD症例のうち，経食道心エコー法でstrandを認めた8例を後方視的に検討した．最大幅3 mm以下の構造物をstrandと定義した．
【結果】strandは斜走する形で存在し，主欠損孔は5例で前上方に位置．5例でカテーテル治療，3例で外科手術を選択した．経食道心エコーをガイドとして，主欠損孔にて2段階のバルーンサイジング（短絡が僅かに残る程度の弱バルーンサイジング法，及びwaistができる程度の強バルーンサイジング法）を行い，strandを含めた辺縁の伸展性を評価．強バルーンサイジング法を指標として閉鎖栓を留置した．1例のみ治療6か月後に残存短絡を極少量認めた．
【結論】strandが辺縁の一部として閉鎖術に利用できる可能性があり，存在する位置と合併する辺縁欠損及び辺縁全体の伸展性を評価することが重要と考える．
【Background】In multi-fenestrated atrial septal defects (MFASD), one defect may rarely be divided into two due to a strand. Therefore, we should be careful during percutaneous transcatheter closure of atrial septal defects (ASD). We investigated the possibility and effects of using a strand as part of the supporting margin during a catheter intervention.
【Methods】This retrospective study included eight cases of ASD with a strand that were treated at our hospital. A structure with a maximum width of 3 mm or less was defined as a strand.
【Results】In all patients, the strands ran diagonally, and five patients had the main defect located in the antero-superior part. Five patients underwent transcatheter device closure and three patients underwent surgical closure. Under transesophageal echocardiography monitoring, we performed two-stage balloon sizing using the weak balloon sizing method where a slight shunt flow remains and the strong balloon sizing method which involves complete disappearance of the shunt flow and a slight balloon waist in the main defect. We then evaluated the compliance of the rim, including the strand. The closure devices were placed with reference to the strong balloon sizing method. Only one patient exhibited a small amount of residual shunt at the six months follow-up.
【Conclusion】The strand may act as a part of the margin for device closure. The defect position and deficient rim should be evaluated, in addition to the compliance of the supporting strand.
Key words: Atrial septal defect; multi-fenestrated; strand; Amplatzer Septal Occluder; Occulutech Figulla Septal Occluder
© 2021 一般社団法人日本先天性心疾患インターベンション学会© 2021 Japanese Society of Congenital Interventional Cardiology
This page was created on 2021-02-09T17:34:18.095+09:00
This page was last modified on 2021-03-22T13:29:18.000+09:00
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