神奈川県立こども医療センター循環器内科Department of Cardiology, Kanagawa Children’s Medical Center
冠動脈瘻（Coronary Artery Fistula: CAF）の中で稀な右冠動脈左室瘻に対し，経皮的閉鎖栓留置を行った初めての症例を報告する．症例は1歳9ヶ月女児で，巨大な右冠動脈左室瘻を有していた．冠動脈computed tomography（CT）及び造影心臓カテーテル検査上，右冠動脈は大動脈起始部より拡張し，本来の冠動脈域を灌流した後に左室へと交通を認めた．形態からカテーテル治療が可能と判断した．まず片側大腿動脈（Femoral Artery: FA）から右冠動脈-左室-大動脈へとガイドワイヤーを通し，対側FAからスネアで把持し引き抜き，ループを形成した．次にウエッジバーマンカテーテルを用い閉塞試験を繰り返しながら，虚血を来さない至適なデバイス留置位置を選定し，デバイス留置を行った．
幼児例の冠動脈心室瘻に対するカテーテル治療の報告は少ない．侵襲が少ないため，症例によっては手術治療の代替となりうる．
We report the first case of catheter closure using Amplatzer vascular plug device for the coronary artery fistula (CAF); draining from the right coronary artery (RCA) into the left ventricle (LV), quite rare pattern among (CAF). A 1-year old girl had a giant right coronary artery – left ventricular fistula. The angiographic computed tomography of coronary artery and the catheter examination showed a dilated RCA from the orifice, feeding the original coronary artery’s region and drained into the LV. Catheter treatment was judged as possible from its anatomy. We inserted a guide wire from the right femoral artery (FA) to RCA-LV-aorta, and grabbed it out with a snare catheter from the left FA to make a loop of guide wire. Occlusion tests were performed repeatedly using balloon to avoid ischemia. The optimal device position was selected cautiously and was detached.
A few cases of catheter device closure of CAF had been reported in infancy. Because of its technical advance, the transcatheter closure of CAF has low mortality rate, shows rapid recovery, and can be an alternative option to surgical treatment in infant cases.
Key words: coronary artery fistula; transcatheter device closure; coronary cameral fistula; Amplatzer vascular plug
© 2019 日本Pediatric Interventional Cardiology学会© 2019 Japanese Society of Pediatric Interventional Cardiology
This page was created on 2019-07-29T13:48:38.315+09:00
This page was last modified on 2019-08-28T18:53:17.000+09:00
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