末梢肺動脈に対するバルーン血管形成術は二心室循環では肺室圧が体血圧の75％以上，それ以下でも臨床症状を有するもの，広範な還流障害がある場合に適応となる．病変が多岐にわたる場合，低年齢の小児，等圧～肺心室圧が体心室圧を凌駕する症例はハイリスクと考え，全身麻酔や二本の静脈シースを確保するなどの準備を考慮する．末梢肺動脈へ到達する経路で心室内を通過する場合，心内構造物を損傷しないよう注意を要する．先天性の病変部では近接正常部径の1.1–1.15倍まで，術後病変では1.5–1.75倍までのNon-compliantバルーンを選択する．拡張中にウエストがバルーン径の50％以上で出現した場合はburst圧まで拡張させ，50％未満でウエストが出現した場合は小径のバルーンに変更する．拡張により生じた瘤が急激に拡大する，既に血管外への露出が見られる場合は血液凝固能を速やかに正常化させ，バルーンを病変部位で再拡張させ止血を図る．瘤の拡大や血管外露出が続く場合はcoilやplugなどでの閉塞を考慮する．
Balloon angioplasty of branch pulmonary artery stenosis is indicated in the patients when pulmonary ventricular pressure is more than 75％ of systemic ventricular pressure and/or they have significant symptoms. General anesthesia and two venous sheaths must be prepared for the patients such as young, with multiple lesions and with over-systemic pulmonary ventricular pressure. The size of the initial balloon must not be larger than 1.1 to 1.15 times the distal reference portions of the vessel in native stenosis, and 1.5 to 1.75 times in post-surgical stenosis. When the resistant waist is less than 50％ of the balloon diameter, full inflation should be avoided and the smaller sized balloon must be used. When the aneurysm is seen in the angiography just after the balloon dilation, this aneurysm should be evaluated after 5 to 30 minutes again. If an aneurysm is enlarging rapidly or there is disruption and breeding, the balloon should be immediately inflated at or slightly proximal to the region to control breeding. If the enlargement of aneurysm or bleeding continues, occlusion of the vessel with coil or plug must be considered.
Key words: branch pulmonary artery stenosis; balloon angioplasty; catheter intervention; non-compliant balloon
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