Effect of Multidisciplinary Approach Including Percutaneous Ventricular Septal Defect Closure for Ventricular Septal Defect with Left Ventricular Systolic Dysfunction
症例は79歳男性．初発の心不全で入院した．心電図で完全左脚ブロック，心エコー図で左室の拡大（拡張末期径74 mm）と収縮低下（駆出率24％），膜様部心室中隔欠損症を認めた．心臓カテーテル検査では冠動脈に有意狭窄なく，心筋生検では二次性心筋症の所見はみられなかった．右心室でO2 step upを認め，肺体血流比は1.66であり，欠損孔閉鎖の適応と考えられた．高齢・低心機能のため開心術のリスクが大きく，経皮的心室中隔欠損閉鎖術を選択した．全身麻酔下で，大腿動静脈間でガイドワイヤーを欠損孔経由でプルスルーし，右心系からAmplatzerTM Duct Occluder Ⅰを留置した．その後，両心室ペ...
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| Published in | Shinzo Vol. 54; no. 7; pp. 803 - 810 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan Heart Foundation
15.07.2022
公益財団法人 日本心臓財団 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo.54.803 |
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| Abstract | 症例は79歳男性．初発の心不全で入院した．心電図で完全左脚ブロック，心エコー図で左室の拡大（拡張末期径74 mm）と収縮低下（駆出率24％），膜様部心室中隔欠損症を認めた．心臓カテーテル検査では冠動脈に有意狭窄なく，心筋生検では二次性心筋症の所見はみられなかった．右心室でO2 step upを認め，肺体血流比は1.66であり，欠損孔閉鎖の適応と考えられた．高齢・低心機能のため開心術のリスクが大きく，経皮的心室中隔欠損閉鎖術を選択した．全身麻酔下で，大腿動静脈間でガイドワイヤーを欠損孔経由でプルスルーし，右心系からAmplatzerTM Duct Occluder Ⅰを留置した．その後，両心室ペーシング機能付き植込み型除細動器（cardiac resynchronization therapy defibrillator；CRT-D）を留置し，至適な薬物治療を加えた．その結果，左室の縮小（拡張末期径47 mm）と収縮改善（駆出率42％）を認め，心不全徴候は軽快した．経皮的心室中隔欠損閉鎖術は低侵襲であり，本例のような高齢・低心機能で外科的手術が高リスクの症例において一つの選択肢と考えられる． |
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| AbstractList | 症例は79歳男性．初発の心不全で入院した．心電図で完全左脚ブロック，心エコー図で左室の拡大（拡張末期径74 mm）と収縮低下（駆出率24％），膜様部心室中隔欠損症を認めた．心臓カテーテル検査では冠動脈に有意狭窄なく，心筋生検では二次性心筋症の所見はみられなかった．右心室でO2 step upを認め，肺体血流比は1.66であり，欠損孔閉鎖の適応と考えられた．高齢・低心機能のため開心術のリスクが大きく，経皮的心室中隔欠損閉鎖術を選択した．全身麻酔下で，大腿動静脈間でガイドワイヤーを欠損孔経由でプルスルーし，右心系からAmplatzerTM Duct Occluder Ⅰを留置した．その後，両心室ペーシング機能付き植込み型除細動器（cardiac resynchronization therapy defibrillator；CRT-D）を留置し，至適な薬物治療を加えた．その結果，左室の縮小（拡張末期径47 mm）と収縮改善（駆出率42％）を認め，心不全徴候は軽快した．経皮的心室中隔欠損閉鎖術は低侵襲であり，本例のような高齢・低心機能で外科的手術が高リスクの症例において一つの選択肢と考えられる． |
| Author | Kubota, Naoki Inomata, Takayuki Hoyano, Makoto Numano, Fujito Sakuma, Minori Ozaki, Kazuyuki Abe, Tadaaki Saito, Akihiko Tsukada, Masanori Kurokawa, Takakuni Ikami, Yasuhiro |
| Author_FL | 塚田 正範 黒川 孝国 久保田 直樹 齋藤 昭彦 佐久間 実のり 阿部 忠朗 尾崎 和幸 沼野 藤人 猪又 孝元 井神 康宏 保屋野 真 |
| Author_FL_xml | – sequence: 1 fullname: 佐久間 実のり – sequence: 2 fullname: 久保田 直樹 – sequence: 3 fullname: 尾崎 和幸 – sequence: 4 fullname: 阿部 忠朗 – sequence: 5 fullname: 塚田 正範 – sequence: 6 fullname: 沼野 藤人 – sequence: 7 fullname: 齋藤 昭彦 – sequence: 8 fullname: 黒川 孝国 – sequence: 9 fullname: 井神 康宏 – sequence: 10 fullname: 保屋野 真 – sequence: 11 fullname: 猪又 孝元 |
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| DocumentTitle_FL | 左心収縮不全を伴う心室中隔欠損症に対し経皮的心室中隔欠損閉鎖術を含む集学的治療を行い良好な経過をたどった1例 |
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| References | 11) 日本循環器学会/日本不整脈心電学会：不整脈非薬物治療ガイドライン(2018年改訂版)．https://www.j-circ.or.jp/cms/wp-content/uploads/2018/07/JCS2018_kurita_nogami.pdf(cited 2021 Apr 01 12) 日本循環器学会/日本心不全学会：急性・慢性心不全診療ガイドライン(2017年改訂版)．https://www.j-circ.or.jp/cms/wp-content/uploads/2017/06/JCS2017_tsutsui_h.pdf(cited 2021 Apr 01 2) Carminati M, Butera G, Chessa M, et al；Investigators of the European VSD Registry：Transcatheter closure of congenital ventricular septal defects：results of the European Registry. Eur Heart J 2007；28：2361-2368 8) Sairanen H, Leijala M, Louhimo I：Surgery for ventricular septal defect. Scand J Thorac Cardiovasc Surg 1991；25：1-5 10) Fujii T, Higaki T, Tomita H, et al：Transcatheter closure of perimembranous ventricular septal defects with Amplatzer® duct occluder I；The first case report in Japan. J Cardiol Cases 2019；20：147-150 4) Miyake T, Shinohara T, Nakamura Y, et al：Spontaneous closure of ventricular septal defects followed up from ＜3 months of age. Pediatr Int 2004；46：135-140 1) Udink Ten Cate FEA, Sobhy R, Kalantre A, et al：Off-label use of duct occluder devices to close hemodynamically significant perimembranous ventricular septal defects：A multicenter experience. Catheter Cardiovasc Interv 2019；93：82-88 9) El-Sisi A, Sobhy R, Jaccoub V, Hamza H：Perimembranous Ventricular Septal Defect Device Closure：Choosing Between Amplatzer Duct Occluder I and II. Pediatr Cardiol 2017；38：596-602 13) Grigoratos C, Liga R, Bennati E, et al：Magnetic Resonance Imaging Correlates of Left Bundle Branch Disease in Patients With Nonischemic Cardiomyopathy. Am J Cardiol 2018；121：370-376 5) van Riel AC, Schuuring MJ, van Hessen ID, et al：Contemporary prevalence of pulmonary arterial hypertension in adult congenital heart disease following the updated clinical classification. Int J Cardiol 2014；174：299-305 3) Alpert BS, Cook DH, Varghese PJ, Rowe RD：Spontaneous closure of small ventricular septal defects：ten-year follow-up. Pediatrics 1979；63：204-206 7) Holzer R, de Giovanni J, Walsh KP, et al：Transcatheter closure of perimembranous ventricular septal defects using the amplatzer membranous VSD occluder：immediate and midterm results of an international registry. Catheter Cardiovasc Interv 2006；68：620-628 6) 日本循環器学会：成人先天性心疾患診療ガイドライン(2017年改訂版)．https://www.j-circ.or.jp/cms/wp-content/uploads/2020/02/JCS2017_ichida_h.pdf(cited 2021 Apr 01 |
| References_xml | – reference: 8) Sairanen H, Leijala M, Louhimo I：Surgery for ventricular septal defect. Scand J Thorac Cardiovasc Surg 1991；25：1-5 – reference: 5) van Riel AC, Schuuring MJ, van Hessen ID, et al：Contemporary prevalence of pulmonary arterial hypertension in adult congenital heart disease following the updated clinical classification. Int J Cardiol 2014；174：299-305 – reference: 6) 日本循環器学会：成人先天性心疾患診療ガイドライン(2017年改訂版)．https://www.j-circ.or.jp/cms/wp-content/uploads/2020/02/JCS2017_ichida_h.pdf(cited 2021 Apr 01) – reference: 12) 日本循環器学会/日本心不全学会：急性・慢性心不全診療ガイドライン(2017年改訂版)．https://www.j-circ.or.jp/cms/wp-content/uploads/2017/06/JCS2017_tsutsui_h.pdf(cited 2021 Apr 01) – reference: 11) 日本循環器学会/日本不整脈心電学会：不整脈非薬物治療ガイドライン(2018年改訂版)．https://www.j-circ.or.jp/cms/wp-content/uploads/2018/07/JCS2018_kurita_nogami.pdf(cited 2021 Apr 01) – reference: 7) Holzer R, de Giovanni J, Walsh KP, et al：Transcatheter closure of perimembranous ventricular septal defects using the amplatzer membranous VSD occluder：immediate and midterm results of an international registry. Catheter Cardiovasc Interv 2006；68：620-628 – reference: 10) Fujii T, Higaki T, Tomita H, et al：Transcatheter closure of perimembranous ventricular septal defects with Amplatzer® duct occluder I；The first case report in Japan. J Cardiol Cases 2019；20：147-150 – reference: 2) Carminati M, Butera G, Chessa M, et al；Investigators of the European VSD Registry：Transcatheter closure of congenital ventricular septal defects：results of the European Registry. Eur Heart J 2007；28：2361-2368 – reference: 13) Grigoratos C, Liga R, Bennati E, et al：Magnetic Resonance Imaging Correlates of Left Bundle Branch Disease in Patients With Nonischemic Cardiomyopathy. Am J Cardiol 2018；121：370-376 – reference: 9) El-Sisi A, Sobhy R, Jaccoub V, Hamza H：Perimembranous Ventricular Septal Defect Device Closure：Choosing Between Amplatzer Duct Occluder I and II. Pediatr Cardiol 2017；38：596-602 – reference: 4) Miyake T, Shinohara T, Nakamura Y, et al：Spontaneous closure of ventricular septal defects followed up from ＜3 months of age. Pediatr Int 2004；46：135-140 – reference: 3) Alpert BS, Cook DH, Varghese PJ, Rowe RD：Spontaneous closure of small ventricular septal defects：ten-year follow-up. Pediatrics 1979；63：204-206 – reference: 1) Udink Ten Cate FEA, Sobhy R, Kalantre A, et al：Off-label use of duct occluder devices to close hemodynamically significant perimembranous ventricular septal defects：A multicenter experience. Catheter Cardiovasc Interv 2019；93：82-88 |
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| Snippet | 症例は79歳男性．初発の心不全で入院した．心電図で完全左脚ブロック，心エコー図で左室の拡大（拡張末期径74 mm）と収縮低下（駆出率24％），膜様部心室中隔欠損症を... |
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| SubjectTerms | 左室収縮不全 心臓再同期療法 経皮的心室中隔欠損閉鎖術 |
| Title | Effect of Multidisciplinary Approach Including Percutaneous Ventricular Septal Defect Closure for Ventricular Septal Defect with Left Ventricular Systolic Dysfunction |
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