新生児大動脈狭窄症の気球大動脈バルブ整形術後の左心臓の成長,機能,再介入
Doff B McElhinney1, James E Lock, John F Keane
1Department of Cardiology, Children's Hospital, and Harvard Medical School, Boston, Mass 02115, USA.
Circulation
|February 3, 2005
まとめ
新生児のトランスキャテーテル気球大動脈弁整形 (BAVP) は,左心臓の構造が1年以内に正常化する,臨界大動脈狭窄 (AS) の短期的な緩和を提供します. しかし,大動脈再発 (AR) または残留ASに対する再介入は一般的であるが,大動脈弁置換はまれである.
科学分野:
- ペディアトリック・カルディオロジー
- 介入性心臓病学 介入性心臓病学
- 生まれながらの心臓病 生まれながらの心臓病
背景:
- トランスキャセター風船大動脈弁整形術 (BAVP) は,新生児における重症大動脈狭窄症 (AS) の主要な治療法です.
- 新生児BAVP後の左心発達と再介入パターンに関するデータは限られている.
研究 の 目的:
- 新生児のBAVP後の左心臓構造の長期的な成長と機能を評価する.
- ASのためにBAVPで治療された新生児の再介入率とアウトカムを分析する.
主な方法:
- 1985年から2002年の間に60日未満でBAVPを受けた113人の患者の遡及的分析.
- 早期の死亡率の評価,単胞性コンバージョンの必要性,および短期的な血液動力学的結果 (梯度減少,大動脈吐) の評価.
- 左心構造の正常化,再介入なしの生存,大動脈弁置換の必要性について,生存者の長期的な追跡調査.
主要な成果:
- 14%の早期死亡率で,後年では著しく減少し,15%が有意な大動脈吐症 (AR) を発症した.
- 左心室 (LV) の終結ダイアストリック寸法と大動脈環のzスコアは,ほとんどの生存者において1~2年以内に正常化した.
- LV流出経路での再介入なしの生存率は5年後には48%,5年後には大動脈弁置換なしの生存率は84%でした.
結論:
- 新生児BAVPはASの短期的な緩和を提供し,ほとんどの左心構造は1年以内に正常化します.
- 残留/再発性ASまたはイアトロゲン性ARに対する再介入は,BAVP後の最初の年に一般的です.
- 新生児のBAVPの後,幼少期に大動脈弁の置換はまれに必要とされる.
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