1 自治医科大学小児科Department of Pediatrics, Jichi Medical University
2 昭和医科大学病院小児循環器・成人先天性心疾患センターPediatric Heart Disease and Adult Congenital Heart Disease Center, Showa Medical University Hospital
小児におけるステント治療では将来の体格成長を見据えて病変部位を成人径まで後拡張可能なデバイスを選択することが望ましい．今回，体重9 kgの異型大動脈縮窄症の1歳5か月児に対し，成人までの成長を見越した後拡張が可能なラージサイズステントを留置しえた症例を経験した．本症例は下行大動脈縮窄部での圧較差が58 mmHg, 大動脈造影での最狭部径は1.1 mm, 狭窄部長は20.5 mmだった．8 Fr Brite Tip®のバルブ部分を7 Fr Brite Tip®のシースカニューレ部分に接続してガイディングシースを作成し，Palmaz P308®をPowerflex® 8.0 mm/4 cmにマウントしてステント留置を行い，有効な拡張が得られた．手技後に右大腿動脈の閉塞を認めたものの，臨床的な症状や血流障害は認められなかった．小児への大口径デバイスの留置には血管径やシースサイズの制約があるが，本症例ではバルーンとステントの工夫により，安全かつ低侵襲な治療を行うことができた．小児期においても，長期的視点に立ったデバイス選択と血管径やアクセス経路を踏まえた手技の工夫が極めて重要である．
In stent implantation in pediatric patients, it is important to select devices that allow for future expansion as patients grow to adult size. We report a case of a 1-year-5-month-old infant (Body weight: 9 kg) with mid-aortic syndrome treated using a large size stent expandable to adult dimensions. The pressure gradient across the coarctation was 58 mmHg, with a minimal diameter of 1.1 mm and a stenosis length of 20.5 mm. A guiding sheath was modified by connecting the hub of an 8 Fr Brite Tip® to the catheter shaft of a 7 Fr Brite Tip®. Palmaz P308® stent was mounted on a Powerflex® 8.0 mm/4 cm balloon and successfully deployed, achieving effective dilation. Although right femoral artery occlusion occurred post-procedure, no clinical symptoms or perfusion issues were observed. The use of large stents in pediatric patients is limited by vessel size and sheath compatibility. However, in this case, procedural modifications enabled a safe and minimally invasive intervention. This case underscores the importance of anticipating growth when selecting devices and customizing procedural strategies based on vessel diameter and vascular access, even in small children.
Key words: coarctation of the aorta; atypical coarctation of the aorta; stent implantation; infant; Vascular access
© 2026 一般社団法人日本先天性心疾患インターベンション学会© 2026 Japanese Society of Congenital Interventional Cardiology
This page was created on 2025-12-18T10:05:11.923+09:00
This page was last modified on 2026-07-24T14:42:58.000+09:00
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