Journal of JCIC

Online edition: ISSN 2432–2342
JCIC学会事務局 JCIC学会事務局
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Journal of JCIC 6(1): 12-16 (2021)


下心臓型総肺静脈還流異常症術後の残存垂直静脈に対し,Amplatzer Vascular Plug IIによる塞栓術を行った成人例Amplatzer Vascular Plug II for transcatheter closure of an unligated vertical vein after a repair of an infracardiac total anomalous pulmonary venous connection

埼玉医科大学国際医療センター 小児心臓科Department of Pediatric Cardiology, Saitama Medical University International Medical Center

受付日:2021年3月10日Received: March 10, 2021
受理日:2021年5月24日Accepted: May 24, 2021
発行日:2021年8月31日Published: August 31, 2021

総肺静脈還流異常症(Total Anomalous Pulmonary Venous Connection; TAPVC)の術後には,循環動態安定化を目的として垂直静脈(Vertical vein; VV)を結紮しない場合がある.下心臓型TAPVC術後の残存VVの多くは自然閉鎖するとされている事から,このような残存VVに対する経カテーテル的塞栓術の報告は極めて少ない.今回,下心臓型TAPVC術後の残存VVに対し,術後遠隔期にAmplatzer™ Vascular Plug II(AVPII; St. Jude Medical, Saint Paul, MN, USA)を用いた塞栓術を行った成人例を経験した.下心臓型TAPVCでは,VVは長い距離を走行するため留置後のデバイス脱落のリスクが懸念される.さらに,本症例ではVVの狭窄が軽度であった事から,通常よりも大きな最小血管径の200%超のAVPII 20 mm×16 mmを使用した.心腔内エコーのガイド下にBrockenbrough法による心房中隔穿通を行い,ジャドキンス型左冠動脈用カテーテル®(Hanako Medical Co., Ltd., Saitama)と0.035インチ ラジフォーカス®を用いてVVにアプローチした.VVへのロングシース挿入に難渋したものの,左房内にデバイスが突出する事なく安全に留置する事ができた.

In some cases of a repair of a total anomalous pulmonary venous connection (TAPVC), the vertical vein (VV) is left unligated in order to stabilize the postoperative hemodynamics. Because it is speculated that most unligated VVs in infracardiac TAPVCs close spontaneously, transcatheter closure of the VVs in infracardiac TAPVCs are rarely reported. Here, we report an adult case who underwent a transcatheter closure of an unligated VV with an Amplatzer™ Vascular Plug II (AVPII; St. Jude Medical, Saint Paul, MN, USA) after a repair of an infracardiac TAPVC. In an infracardiac TAPVC, migration of the device is of concern after the deployment because of the long VV running across the diaphragm towards the portal vein. Also, because the VV stenosis was mild in this case, we deployed a 20 mm×16 mm AVPII, which was more than 200% the size of the smallest vessel diameter. Under the guidance of an intracardiac echocardiogram, we performed an interatrial septal puncture by the Brockenbrough method. Then, we approached the VV with a Judkins Left guiding catheter® (Hanako Medical Co., Ltd., Saitama) and 0.035 inch Radifocus® (Terumo Inc., Tokyo) guidewire. Though the insertion of a long sheath into the VV was difficult, we could deploy the device without a protrusion into the left atrium.

Key words: Amplatzer Vascular Plug II; total anomalous pulmonary venous connection; vertical vein

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