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 JPIC 1(2): 43-52 (2016)


バルーン肺動脈弁形成術/バルーン肺動脈形成術Percutaneous Transluminal Pulmonary Valvuloplasty of Pulmonary Valve Stenosis and Percutaneous Transluminal Angioplasty of Pulmonary Artery Stenosis

自治医科大学とちぎ子ども医療センター小児手術・集中治療部Pediatric Operating Suite and Intensive Care Unit, Jichi Children’s Medical Center Tochigi ◇ Tochigi, Japan

受付日:2016年11月18日Received: November 18, 2016
受理日:2016年12月11日Accepted: December 11, 2016
発行日:2016年12月31日Published: December 31, 2016

経皮的バルーン肺動脈弁形成術(PTPV)は,肺動脈弁狭窄に対する第一選択の治療で,治療適応基準は圧較差≧40 mmHgである.通常耐圧で,肺動脈弁輪径の120~125%のバルーンが推奨されている.肺血流遮断時間を可及的に短くするよう,PTPV手技は速やかに行う.施術後の一過性右室流出路狭窄にはβ遮断薬を投与する.拡大目標径が大きい場合には,ダブルバルーン法を用いる.本邦ではステント使用に制限があり,未手術および術後瘢痕性肺動脈狭窄の一次治療に経皮的バルーン血管形成術(PTA)が選択されることが多い.一般的な治療適応基準は圧較差≧20 mmHgで,狭窄近位肺動脈圧(収縮期右室圧)/大動脈圧比≧0.7または患側/健側の肺血流比≦0.5である.高耐圧で,最狭窄部径の300~350%かつ参照血管径の150%を超えないバルーンを使用する.硬い病変では≧15 atmの超高耐圧で,最狭窄部径の200%程度のバルーンが推奨される.PTA無効例にはカッティングバルーンの併用やステント留置が行われる.

Recently percutaneous transluminal pulmonary valvuloplasty (PTPV) has gained acceptance as the first option in the management of congenital pulmonary valve stenosis. It is generally recommended that the procedure be performed for peak-to-peak gradients ≧40 mmHg with standard-pressure balloons with balloon/annulus ratio of 1.2 to 1.25. The duration of inflation is kept as short as possible to minimize blocking pulmonary blood flow. Immediate after PTPV, β-blockade therapy is generally recommended if significant stenosis of right ventricular outflow tract occur. When the pulmonary valve annulus is too large to dilate with a single balloon, double balloon valvuloplasty may be performed. Because there is limitation of use of stents for vascular stenosis in Japan, many interventional cardiologists tend to perform percutaneous transluminal angioplasty (PTA) as the first option in the management of pulmonary artery stenosis which is either native or post-surgery. It is generally recommended that the procedure be performed for gradients ≧20 mmHg, pressure-ratio of proximal pulmonary artery (or right ventricle)/systemic artery ≧0.7, or perfusion-ratio of affected lung/healthy lung ≦0.5. The recommendation is to use high-pressure balloons that have diameter of 3.0–3.5 times the most stenotic regions and less than 1.5 times the reference vessels. If the lesion is too hard, the recommendation is to use ultra-high-pressure balloons (≧15 atms) that have diameter approximately 2.0 times the most stenotic regions. If PTA is ineffective, alternative equipment such as cutting balloons or implantation of stents may be considered.

Key words: pulmonary valve stenosis; pulmonary artery stenosis; intervention; valvuloplasty; angioplasty

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