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): 53-58 (2016)


動脈管のコイル塞栓術:これから始める人のためにHow to Close Small Patent Ductus Arteriosus Using Coils: For Young Beginner

久留米大学小児科Department of Pediatrics and Child Health, Kurume University School of Medicine

受付日:2016年10月31日Received: October 31, 2016
受理日:2016年12月8日Accepted: December 8, 2016
発行日:2016年12月31日Published: December 31, 2016

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

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