Journal of JPIC

Online edition: ISSN 2432–2342
JPIC学会事務局 JPIC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 2(2): 56-61 (2017)
doi:10.20599/jjpic.2.56

原著Original Article

新生児/乳児早期の症候性動脈管開存症に対するカテーテル治療Ttranscatheter patent ductus arteriosus closure in small children

1地域医療機能推進機構九州病院(JCHO)九州病院小児科Department of Pediatrics, Japan Community Healthcare Organization, Kyushu Hospital ◇ 1–8–1 Kishinoura, Yahatanishiku, Kitakyushu, Fukuoka 806–8501, Japan

2山口大学大学院医学系研究科医学専攻小児科学講座Department of Pediatrics, Yamaguchi University Graduate School of Medicine ◇ 1–1–1 Minamikogushi, Ube, Yamaguchi 755–8505, Japan

受付日:2017年11月9日Received: November 9, 2017
受理日:2017年12月5日Accepted: December 5, 2017
発行日:2017年12月31日Published: December 31, 2017
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背景:本邦では2016年から生後6か月未満,体重6 kg未満の児に対してもAmplatzer™ Duct Occlude-I(ADO I)留置が可能となり,新生児/乳児早期の症候性PDAに対するカテーテル治療が増加してくると考えられる.しかしながら,国内の新生児/乳児早期PDAのカテーテル治療成績に関する知見は不足している.

方法:新生児/乳児早期の症候性PDA自験7例を後視的に検討した.

結果:在胎週数38(25–40)週,出生体重2,768 (635–3,218) g,治療時年齢4か月(生後13日–5か月),治療時体重3,810 (2,880–6,370) gであった.PDA最小径は3.8 (1.1–5.3) mm,形態はKrichenko分類A型4例,C型2例,およびE型1例であった.使用したデバイスはADO I 4例,Amplatzer™ Vascular Plug II 3例であった.全例完全閉鎖し,重篤な合併症はなかった.軽症の左肺動脈狭窄を1例認めた.

考察:従来手術を選択せざるを得なかった新生児/乳児早期症候性PDA症例に対しても,カテーテル閉鎖術が第一選択となる可能性が示唆された.

Background: Since 2016, an Amplatzer™ duct occluder I has been used in neonates and infants aged <6 months and weighed <6 kg. We aimed to determine the feasibility and efficacy of transcatheter closure of patent ductus arteriosus (PDA) in this pediatric age group.

Methods: We reviewed the hospital and catheterization records of early infants who underwent transcatheter closure of PDA at our hospital. We carefully recorded all procedural details, complications, and short and mid-term outcomes.

Results: Seven infants at gestational age of 38 (25–40) weeks underwent transcatheter closure of PDA using the Amplatzer™ Duct Occluder I or the Amplatzer™ Vascular Plug II. The median age and weight were 4 months (range between 13 days and 5 months) and 3,810 (2,880–6,370) g, respectively. The median smallest ductal diameter on angiography was 3.8 (1.1–5.3) mm. Four patients demonstrated a type A PDA, 2 demonstrated a type C, and 1 demonstrated a type E. Complete closure was achieved in all patients with no major procedural complications. The development of mild left pulmonary arterial stenosis was reported in 1 patient.

Conclusion: Our case series showed that transcatheter closure of PDA can be performed even in small children.

Key words: catheter intervention; infant; neonate; patent ductus arteriosus; premature

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