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 2(2): 62-66 (2017)

症例報告Case Report

ステント留置中のバルーン破裂:陽子線治療後の多発性肺動脈狭窄に対するカテーテル治療の成人例Pinhole rupture during stenting: Catheter intervention for multiple pulmonary stenoses associated with proton therapy

1昭和大学横浜市北部病院循環器センターCardiovascular Center, Showa University Northern Yokohama Hospital

2昭和大学横浜市北部病院こどもセンターChidlren’s Medical Center, Showa University Northern Yokohama Hospital

受付日:2017年10月26日Received: October 26, 2017
受理日:2017年11月21日Accepted: November 21, 2017
発行日:2017年12月31日Published: December 31, 2017

多発性肺動脈狭窄は右心不全の原因となり,再灌流性肺障害予防のため段階的に狭窄部位を拡大することが推奨されている.症例は69歳男性,59歳時に左肺門部の悪性線維性組織球症と診断され陽子線治療を受けたが,61歳時に再発し左肺全摘術を受けた.69歳時に労作時呼吸困難が出現,前医で精査の結果,陽子線治療後の右多発性肺動脈狭窄に伴う右心不全と診断され,カテーテル治療目的に紹介となった.1回目の治療で,中葉枝,下葉枝の狭窄に対しバルーン拡大を行い,2回目の治療で主幹部狭窄にPalmaz P3008の留置を行った.ステント留置時にバルーンのPinhole ruptureを認めたが,造影剤の高圧注入にて圧着拡大を行い,最終的に右室圧は体血圧の9割から6割まで低下した.多発性肺動脈狭窄に起因する右心不全に対し,段階的に拡大術を行うことで,重篤な呼吸障害は認めず右室圧を低下させることができた.

Multiple pulmonary arterial stenoses cause the right heart failure. The staged dilation for these multiple stenoses is recommended to prevent the reperfusion pulmonary injury. We report successful staged dilation for multiple stenoses of the right pulmonary artery in 69-year-old man. He was diagnosed as malignant fibrous histiocytoma at the left hilar region and received the proton therapy at 59-year-old, but it recurred and total left pneumonectomy was performed at 61-year-old. After that, he complained of exertional dyspnea and was diagnosed with the right heart failure associated with multiple right pulmonary arterial stenoses, which was caused by the proton therapy. He was referred to our center for the catheter intervention to alleviate the multiple stenoses. In the first session, we performed the balloon dilation for the middle and lower branch arteries. In the second session, we deployed P3008 stent for the right main trunk stenosis. In this session, although the balloon had a pin-hole rupture, we expanded the stent successfully using power injection of contrast medium. His right ventricular pressure finally decreased from 90% to 60% of his systemic blood pressure. The staged dilation for the multiple pulmonary arterial stenoses can decrease the right ventricular pressure and improve the right heart failure without reperfusion pulmonary injury.

Key words: multiple pulmonary arterial stenoses; reperfusion pulmonary injury; pin-hole rupture; power injection

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