公益財団法人日本心臓血圧研究振興会附属榊原記念病院小児科Department of Pediatric Cardiology, Sakakibara Heart Institute ◇ Tokyo, Japan
背景：Amplatzer™ Duct Occluder-I（ADO I）では閉鎖困難と想定される形態の動脈管に対して，海外ではAmplatzer™ vascular plug II（AVPII）を用いた閉鎖術が報告されている．しかし，本邦における報告は少なくAVPIIのサイズ選択や留置方法，中長期的な安全性について一定の見解はない．
目的：PDAに対するAVPIIを用いた閉鎖術において，閉鎖栓のサイズ選択や留置手技に関する方法論を考案すること．
対象と方法：当院においてAVPIIを用いてPDA閉鎖術を実施した2症例5サイズのAVPIIの留置形態を後方視的に検討し，PDAサイズおよび形態に応じた適切なAVPII選択と留置方法の検討を行った．
結果：症例1はKrichenko分類C型，肺動脈側3.7 mm，長径18.8 mmの動脈管に対して，まずAVPII10 mm，次にAVPII14 mmの留置を試みたが，いずれも良好な留置形態を得られず回収．最終的にAVPII12 mmを留置した．症例2はKrichenko分類E型，肺動脈側6.1 mm，長径17.0 mmの動脈管に対して，まずAVPII12 mmの留置を試みたが，軽いwiggle testで肺動脈内に脱落したため回収．最終的にAVPII16 mmを留置した．変更の要因は閉鎖栓とPDAの径のミスマッチによる不安定性と留置後の閉鎖栓の長さと動脈管長のミスマッチの2点に要約された．特に留置後の閉鎖栓の長さが治療の成否に重要であるが変化の幅は大きい．本検討から留置後閉鎖栓の長さはカタログ上の閉鎖栓の径×長さを管状動脈管径で除した数値で予測できると考案した．
結論：管状の長いPDAに対してAVPIIは安全に使用でき，良い適応になると考えられた．閉鎖栓サイズの選択については，最小径，膨大部径，留置後の閉鎖栓想定長の三者を総合して決定するアルゴリズムが必要である．
Background: Transcatheter closure of patent ductus arteriosus (TC-PDA) using Amplatzer™ vascular plug II (AVPII) have been reported overseas in the case where Amplatzer™ Duct Occluder-I (ADO I) does not fit. However, there have been few reports in Japan, especially device selection and deployment methods.
Purpose: To develop a method for device selection and deployment in TC-PDA using AVPII.
Object and Methods: We retrospectively examined the deployment of AVPII with 5 different sizes in 2 patients who underwent TC-PDA using AVPII in our hospital and examined the appropriate AVPII selection and deployment methods according to PDA size and shape.
Results: Case1 had PDA of Krichenko type C with PA side diameter of 3.7 mm and length of 18.8 mm. We attempted to place AVPII10 mm at first, and then AVPII14 mm, however both did not fit in PDA and were retrieved. Finally we successfully deployed AVPII12 mm. Case2 had PDA of Krichenko type E with PA side diameter of 6.1 mm and length of 17.0 mm, we attempted to place AVPII12 mm at first, the device was migrated into the pulmonary artery with a light wiggle test and was retrieved. Finally we successfully deployed AVPII16 mm. The factors of exchange were summarized in two points, the instability due to the mismatch of the diameter of the PDA and device as well as the length of PDA and device after deployment. From this study, we developed the simple method in that the length of device after deployment can be predicted by the diameter×length of device on the catalog divided by the diameter of the tubular PDA.
Conclusion: AVPII can be safely used for long tubular PDA, which is considered to be a good indication. Regarding the selection of the device size, an algorithm is required to comprehensively determine the minimum diameter of the device in relation to the PDA diameter and predict device length after deployment.
Key words: Patent ductus arteriosus; Amplatzer™ vascular plug II; Transcatheter closure
© 2019 日本Pediatric Interventional Cardiology学会© 2019 Japanese Society of Pediatric Interventional Cardiology
This page was created on 2019-07-30T15:03:11.65+09:00
This page was last modified on 2019-08-28T18:50:39.000+09:00
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