榊原記念病院 小児循環器科Depertment of Pediatric Cardiology, Sakakibara Heart Institute
【背景】Gore® Cardioform ASD occluder（以下GCA）は心房壁への圧迫の緩和が期待できる閉鎖栓で，従来の閉鎖栓では留置が困難なリム欠損症例や中隔のMalalignment症例に対しても治療可能な閉鎖栓として注目されている．GCA治療後の短期予後を文献的考察を加え検討した．
【方法】対象は2021年10月から2022年8月にGCA適応基準を満たした二次孔型心房中隔欠損23例で，治療前後の経胸壁，経食道心エコー図，レントゲン画像結果，臨床症状を後方視的に検討した．
【結果】実施年齢の中央値は58歳，Qp/Qsの中央値は1.6, Septal malalignment症例は1例（4.3％），大動脈側リム欠損症例は9例（39％）に認めたが，留置後，閉鎖栓の脱落，Erosion, 有意な遺残短絡を呈する症例はなかった．不整脈は7例（30％）に認め，1例はアブレーション治療を要したが再燃なく経過した．Wire frame fractureは4例（17.4％）に認めたが臨床的な問題を起こさず経過した．
【結語】治療後に重大な合併症は認めず，GCAはリム欠損症例やSeptal malalignment症例に対しても安全に使用できる閉鎖栓と考える．
【Background】Gore® Cardioform ASD occluder (GCA) is a type of occluder that is expected to reduce the atrial wall compression, and hence has been considered to be useful for patients with rim defects and atrial septal malalignment. We here analyzed the short-term results of patients after closure of the atrial septum using GCA, together with a literature review.
【Methods】A total of 23 patients with ostium secundum ASD who fulfilled the applicability criteria for GCA between October 2021 and August 2022. Findings of transthoracic/transesophageal echocardiography and chest X-ray, and clinical symptoms were analyzed retrospectively.
【Results】The median age of the patients at the time of treatment was 58 years. The mean value of Qp/Qs was 1.6. One patient (4.3％) had malalignment of the atrial septum. Nine patients had a rim defect on the aortic side; however, there were no patients in whom the occluder became degraded, who had erosion, or a residual shunt after placement of a GCA for atrial septum. Seven patients (30％) developed arrhythmia, and 1 of the 7 patients required catheter ablation. None of the patients showed relapse of arrhythmia. Wire frame fracture occurred in 4 patients (17.4％), but this did not result in any clinical problems.
【Conclusion】We considered that GCA is a safe occluder that can be used in patients with rim defects and malalignment of the atrial septum, which does not cause any serious complications after closure of the atrial septum.
Key words: Gore® Cardioform ASD Occluder; ASD secundum; wire frame fracture; arrhythmia; erosion
© 2023 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© 2023 Japanese Society of Congenital Interventional Cardiology
This page was created on 2023-09-08T14:21:50.459+09:00
This page was last modified on 2023-10-11T10:39:49.000+09:00
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