下大静脈閉鎖不全患者における左心耳閉鎖術のための肝内静脈アクセス
Pablo D Liva1, Guillermo Eisele2, Marcelo A Agüero1
1Department of Interventional Cardiology, Instituto de Cardiología de Corrientes "Juana Francisca Cabral", Corrientes, Argentina.
JACC. Case reports
|January 21, 2026
まとめ
肝内静脈アクセスは、下大静脈閉鎖不全患者における左心耳閉鎖術(LAAO)の安全な代替法を提供する。このアプローチは、構造的心臓介入における複雑な静脈解剖に不可欠である。
科学分野:
- 循環器病学
- インターベンショナルカーディオロジー
- 構造的心臓介入
背景:
- 左心耳閉鎖術(LAAO)は、経口抗凝固薬を使用できない非弁膜性心房細動患者の脳卒中予防戦略である。
- LAAO処置には通常、標準的な大腿静脈アクセスが使用される。
研究 の 目的:
- 先天性下大静脈閉鎖不全患者における肝内静脈アクセスを用いたLAAOの成功例を報告する。
- 複雑な構造的心臓介入における代替静脈アクセスルートの実現可能性と安全性を強調する。
主な方法:
- 非弁膜性心房細動および出血リスクの高い78歳女性がLAAOのため紹介された。
- 予期せぬ先天性下大静脈閉鎖不全のため、最初の処置は中止された。
- 2回目の試みでは、LAAO処置のために肝内静脈アクセスが成功裏に利用された。
主要な成果:
- LAAOのための肝内静脈アクセスアプローチは、合併症なく安全に完了した。
- これは、標準的な大腿静脈アクセスが不可能な場合の実行可能な代替法を実証する。
結論:
- 肝内静脈アクセスは、下大静脈奇形患者におけるLAAOの安全かつ実行可能な代替法である。
- 構造的心臓介入中の複雑な静脈解剖の管理には、処置前の画像評価と適応可能なアクセス戦略が不可欠である。
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