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): 28-32 (2023)

症例報告Case Report

Amplatzer Duct Occluder留置後のデバイス展開不良と大動脈への突出に対しバルーン拡大術により改善を得た動脈管開存の一例A case report: Successful balloon dilatation for inadequately deployed Amplatzer duct occlude and protrusion to the descending aorta after percutaneous patent ductus arteriosus closure.

1富山大学附属病院小児科Department of Pediatrics, Toyama University Hospital, Toyama, Japan

2福井循環器病院小児科Department of Pediatrics, Fukui Cardiovascular Center, Fukui, Japan

受付日:2022年7月25日Received: July 25, 2022
受理日:2023年1月12日Accepted: January 12, 2023
発行日:2023年3月31日Published: March 31, 2023

経皮的動脈管閉鎖術において,大動脈へのデバイス突出は注意の必要な合併症の一つである.症例は生後9カ月,体重6.8 kgの女児で,体重増加不良があり経皮的動脈管閉鎖術のため当院へ紹介となった.心臓超音波検査で肺動脈側最小径6.0 mmの大きな動脈管(Krichenko type A)を認めた.大動脈造影で動脈管の肺動脈側径4.9 mm,大動脈側径13.9 mmに対してAmplatzer™ Duct Occluder(ADO)10/8を留置したところ,肺動脈側へ脱落した.ADO 12/10に変更し再留置を行ったが,デバイスはretention skirtの展開が不十分な形で留置され,大動脈側への突出を認めた.デバイスの大動脈側でTyshak II 12 mm×3 cmによる拡大を行い,ADOのretention skirtは良好な形態となり,大動脈側への突出も改善した.経皮的動脈管閉鎖術において,デバイスの展開不良と大動脈側への突出に対し,バルーン拡大術による整形は有用な手技となりうる.

The device protrusion into the aorta is one of serious complications in children, especially small infants, who undergo transcatheter device closure of patent ductus arteriosus (PDA). We present the case of a girl with PDA in whom a PDA device protruding into the aorta was successfully reshaped by balloon dilatation. A 9-month-old girl weighing 6.8 kg who had failure to thrive was referred to our hospital for percutaneous PDA closure. Echocardiography showed a large conical PDA measuring 6.0 mm at its narrowest diameter. As aortography showed a Krichenko A type PDA with the pulmonary and Aortic side diameter of 4.9 mm and 13.9 mm respectively, we deployed Amplatzer™ Duct Occluder (ADO) 10/8 from the pulmonary side. However, it migrated into the main pulmonary artery before releasing. Subsequently, an ADO 12/10 was placed in the PDA. As it was oversized, retention skirt seemed to be inadequately deployed and protruded toward the aorta. Balloon dilatation with Tyshak II 12 mm×3 cm was performed on the aortic side of the device, which resulted in better shape of the retention skirt and improved device protrusion toward the aorta. Balloon dilatation can be a feasible procedure to reshape the device protruding into the aorta in infants who undergo transcatheter device closure of PDA.

Key words: patent ductus arteriosus; percutaneous patent ductus arteriosus closure; Amplatzer Duct Occluder; balloon dilatation

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