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 7(2): 13-23 (2023)


心房中隔欠損と動脈管開存用閉鎖栓の回収手技Transcatheter retrieval of atrial septal defect and patent ductus arteriosus occluders

昭和大学病院 小児循環器・成人先天性心疾患センターPediatric Heart Disease and Adult Congenital Heart Disease Center, Showa University Hospital

受付日:2023年2月20日Received: February 20, 2023
受理日:2023年3月15日Accepted: March 15, 2023
発行日:2023年3月31日Published: March 31, 2023

経皮的心房中隔欠損閉鎖術,経皮的動脈管開存閉鎖術は,近年あらたな閉鎖栓の導入などで安全性が向上し,適応も拡大されている.しかし,有害事象の一つである閉鎖栓の脱落は完全には克服されておらず,脱落した閉鎖栓の回収方法は十分には確立しているとはいえない.脱落した閉鎖栓の回収方法に関する知識は,術者にとって安全に手技を行う上で必要不可欠であるが,一方で,各術者が実際の臨床で十分に経験を積むことは困難である.JCIC-CVIT教育委員会 医療安全部会では,本邦で心房中隔欠損,動脈管開存に使用されている閉鎖栓,AMPLATZER® septal occluder(Abbott, St Paul, MN, USA),Figulla® Flex II(Occlutech GmbH, Jena, Germany),AMPLATZER® duct occluder(Abbot),AMPLATZER® duct occluder II(Abbott),AMPLATZER® Vascular Plug II(Abbott)に関して,閉鎖栓回収手技のベンチテストを行い,その結果に基づいて適正と思われる回収手技,必要物品を検討してきた1).今回,新たに導入されたGORE® Cardiofrom ASD occluder(GORE Medical, Flagstaff, AZ, USA),AMPLATZER® Piccolo occluder(Abbott)に関しても追加でベンチテストを行い,従来の閉鎖栓と併せてその結果を整理し,適正と思われる回収手技,必要物品に関して総括した.

Device embolization remains a major complication in transcatheter closure of atrial septal defect and patent ductus arteriosus. Although percutaneous retrieval is feasible in the majority of cases, surgical retrieval may be required in some circumstances. For successful transcatheter retrieval of an embolized device, both capturing the devices and complete recapture into a retrieval sheath are necessary. However, the methods of transcatheter device retrieval have not been completely established because these are affected by type and size of the device, location of the embolized device, patient characteristics and operator experience. To achieve safety of device retrieval, it is essential to have sufficient knowledge of the detailed device characteristics and to be familiar with the procedures for device retrieval. However, it is difficult for individual operators to obtain sufficient experience in real clinical settings. The Medical Safety Committee, Board of Education, Japanese Society of Congenital Interventional Cardiology (JCIC) have been developed a guidance for device retrieval in atrial septal defect and patent ductus arteriosus based of bench tests. These bench tests have been performed to verify the appropriate retrieval method according to the device type and size for AMPLATZER® Septal Occluder (Abbott, Chicago, IL, United States of America), Figulla® Flex II (Occlutech GmbH, Jena, Germany), AMPLATZER® Duct Occluder-I (Abbott), AMPLATZER® Duct Occluder-II (Abbott), and AMPLATZER® Vascular Plug-II (Abbott). Recently, additional bench tests were performed on the newly introduced devices, GORE® Cardioform ASD Occluder (GCA) (Gore Medical, Flagstaff, AZ, USA) and the AMPLATZER® Piccolo Occluder (Abbott), and organized the results together with those of conventional devices. Based on these findings, the appropriate retrieval techniques and equipment were reviewed.

Key words: Catheter intervention; Atrial septal defect; Ductus arteriosus; Device embolization; Percutaneous retrieval of embolized device

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