久留米大学小児科Department of Pediatrics and Child Health, Kurume University School of Medicine
動脈管開存症（PDA）コイル塞栓術は，症例が多く小児循環器医が行うカテーテル治療として重要な手技の一つである．Amplatzer duct occulderの登場によって，コイルの役割は2 mm未満のPDAとなった．PDAは盲端の血管ではないので，コイル脱落のリスクやコイルによる周囲の大血管への狭窄のリスクなどを考慮すべきで繊細な手技である．4 FrカテーテルをPDAに通過させ，Flipper detachable coil（Cook社）を肺動脈側に1巻弱，大動脈側に残りを留置するのが典型的な方法である．側面像の下行大動脈造影でPDA形態を計測し最狭窄部の2倍以上のループ径のコイルを選択し，PDA形態によって大動脈側からや肺動脈から留置する．PDAコイル閉鎖術を始めたい小児循環器医に知ってほしい基本的な手技の手順と合併症予防や発生時の対処なども含め解説する．
Coil occlusion of patent ductus arteriosus (PDA) is the one of the common procedures that has been performed by pediatric cardiologists. Since Amplatzer Duct Occluder is available in Japan, coil occlusion is indicated only PDA with <2 mm of diameter. Typically, using 4 Fr catheter, Flipper detachable coil is placed with <1 loop in pulmonary artery and the remaining part in the aortic ampulla. Based on descending aortography in lateral projection, the size of PDA is measured. The loop size of coil is chosen as loop diameter >2 times of the minimum diameter of PDA. Coil is deployed either from aorta or from pulmonary artery depending on the anatomy of PDA. Because PDA connects pulmonary artery and aorta, coil may dislodge or cause obstruction of the adjacent vessels. In this article, I describe basic techniques of coil placement, possible complication, and the way to prevent complication for young beginner.
Key words: patent ductus arteriosus; coil embolization; catheter intervention
© 2016 日本Pediatric Interventional Cardiology学会© 2016 Japanese Society of Pediatric Interventional Cardiology
This page was created on 2016-12-14T15:02:15.302+09:00
This page was last modified on 2016-12-27T11:19:28.534+09:00
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