Pediatric Cardiology and Cardiac Surgery最新文献_第2页

TEG<sup>®</sup> 6s Could Be Useful for Heparin Control in Pediatric Extracorporeal Membrane Oxygenation: A Case Report TEG< sup&gt®& lt; / sup>6可能有助于儿童体外膜氧合中肝素的控制:1例报告

Pediatric Cardiology and Cardiac Surgery Pub Date : 2023-02-01 DOI: 10.9794/jspccs.39.39

Yuki Ogasawara, Wataru Sakai, Tomohiro Chaki, Madoka Mantoku, Kazunori Akai, Tomohiro Nawa, Yuki Ichisaka, Hidetsugu Asai, Noriyoshi Ebuoka, Junichi Oba, Michiaki Yamakage

{"title":"TEG<sup>®</sup> 6s Could Be Useful for Heparin Control in Pediatric Extracorporeal Membrane Oxygenation: A Case Report","authors":"Yuki Ogasawara, Wataru Sakai, Tomohiro Chaki, Madoka Mantoku, Kazunori Akai, Tomohiro Nawa, Yuki Ichisaka, Hidetsugu Asai, Noriyoshi Ebuoka, Junichi Oba, Michiaki Yamakage","doi":"10.9794/jspccs.39.39","DOIUrl":"https://doi.org/10.9794/jspccs.39.39","url":null,"abstract":"小児領域におけるV-A体外式膜型人工肺（veno-arterial extracorporeal membrane oxygenation: V-A ECMO）では，一般的に活性化凝固時間（activated clotting time: ACT）を指標とし180から200秒に維持するようヘパリン投与量を決定している．しかし臨床的にはACTをもとにしたヘパリンコントロールは困難であり，脳出血など致命的な出血性合併症を起こしうる．成人ECMO中のヘパリンコントロールに関しては，血液粘弾性検査装置：TEG® 6sが有用と報告があるが，小児に関する知見はない．今回，TEG® 6sを使用して小児ECMO中のヘパリンコントロールを行った報告をする．症例は大動脈弁上狭窄症，冠動脈狭窄症術前の6カ月の女児で，体重は6.6 kgだった．心不全コントロールが困難であったためV-A ECMOを導入した．V-A ECMO施行中，ACTは130～150秒と低値を示しヘパリンの増量を要求した．一方でTEG® 6sはCK R–CKH R値が測定上限を超え，ヘパリン残存量過多を示し減量を要求した．TEG® 6sの値をもとにヘパリン量を減量したが，出血・血栓性合併症を認めることなく計10日間のV-A ECMOが可能であった．TEG® 6sを用いて小児ECMO下の良好なヘパリンコントロールを得ることができたと考えられた．","PeriodicalId":19794,"journal":{"name":"Pediatric Cardiology and Cardiac Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136019631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

二心室修復術後の蛋白漏出性胃腸症二心室修复术后の蛋白漏出性胃肠症

Pediatric Cardiology and Cardiac Surgery Pub Date : 2023-02-01 DOI: 10.9794/jspccs.39.16

Shin Ono

引用次数: 0

ECMO管理中の凝固評価 ECMO管理中的凝血评估

Pediatric Cardiology and Cardiac Surgery Pub Date : 2023-02-01 DOI: 10.9794/jspccs.39.46

Hironori Ebishima

引用次数: 0

Coronary Obstructive Complication Following Coronary Transfer Procedures for Congenital Heart Disease: Evaluation of Surgical Managements and Proposal for Guidelines 先天性心脏病冠状动脉转移手术后的冠状动脉阻塞性并发症:外科治疗的评估和指南建议

Pediatric Cardiology and Cardiac Surgery Pub Date : 2023-02-01 DOI: 10.9794/jspccs.39.3

Soichiro Kitamura

{"title":"Coronary Obstructive Complication Following Coronary Transfer Procedures for Congenital Heart Disease: Evaluation of Surgical Managements and Proposal for Guidelines","authors":"Soichiro Kitamura","doi":"10.9794/jspccs.39.3","DOIUrl":"https://doi.org/10.9794/jspccs.39.3","url":null,"abstract":"冠動脈移植手術（coronary transfer）を要する小児期手術後の冠動脈狭窄や閉塞は稀であるが，重篤な合併症で手術死・遠隔死の重要な原因となる．この早期発見と早急な対処は手術成績，遠隔期成績の改善に通じる．この合併症は新生児期に行う大血管転位症に対する動脈スイッチ手術（arterial switch operation: ASO）において特に重要である．低体重で，かつ冠動脈の異常が少なくないからである．この合併症に対して2つの手術法が存在するが，その適応基準は定められていない．1つは外科的冠動脈口パッチ形成術（surgical ostial angioplasty: SOAP），他は内胸動脈グラフトを用いた小児冠動脈バイパス法である（pediatric coronary artery bypass surgery with an internal thoracic artery graft: PCABS-ITA）．両法にはそれぞれ利点と欠点があるが，早期成績には両者の差は明らかでない．現状では病変の重症度と範囲に鑑みながら，急性期の緊急救命手術にはSOAPがI（C），PCABS-ITAがIIa（C），ASO術後遠隔期の冠閉塞には，新大動脈の拡張や弁閉鎖不全，右室流出路狭窄等がなければPCABS-ITAがI（C），SOAPがIIa（C）と考えている．今後，遠隔成績の追跡が重要となる．幸い稀な合併症であるため，databaseによる遠隔成績の解析が必須である．","PeriodicalId":19794,"journal":{"name":"Pediatric Cardiology and Cardiac Surgery","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135202200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

心房内血流転換術後の蛋白漏出性胃腸症：2例の経験と文献レビュー心房内血流转换术后蛋白漏出性胃肠病:2例经验及文献回顾

Pediatric Cardiology and Cardiac Surgery Pub Date : 2023-02-01 DOI: 10.9794/jspccs.39.9

Mizuki Yano, Akiharu Omori, Kaname Satoh, Yosuke Ogawa, Yu Tanaka, Kazuhiro Shiraga, Hikoro Matsui, Yasutaka Hirata, Ryo Inuzuka

{"title":"心房内血流転換術後の蛋白漏出性胃腸症：2例の経験と文献レビュー","authors":"Mizuki Yano, Akiharu Omori, Kaname Satoh, Yosuke Ogawa, Yu Tanaka, Kazuhiro Shiraga, Hikoro Matsui, Yasutaka Hirata, Ryo Inuzuka","doi":"10.9794/jspccs.39.9","DOIUrl":"https://doi.org/10.9794/jspccs.39.9","url":null,"abstract":"蛋白漏出性胃腸症（protein-losing enteropathy: PLE）は，先天性心疾患領域でしばしば経験される合併症だが，Fontan例に典型的であるのに比して，非Fontan例での報告は少ない．今回，修正大血管転位症の心房内血流転換術後遠隔期に発症したPLEの2例に対し，それぞれ手術による下大静脈baffle狭窄解除と，経皮的血管形成術による上大静脈baffle狭窄解除を施行し，PLEの寛解を得た．これまでに心房内血流転換術後のPLEは自験例を含めて12例の報告があり，うち11例（92％）にbaffle狭窄ないし閉塞が認められた．狭窄部位は上大静脈のみが5例，下大静脈のみが2例，その両者が4例であった．狭窄を認めた11例全てで外科手術またはカテーテル治療による狭窄解除が施行され，11例中8例（73％）で有効性が報告された．baffle狭窄は心房内血流転換術後に発生するPLEの主要な原因であり，上下大静脈いずれの狭窄例でもPLEの発症が起こり得る．また外科手術やカテーテル治療による狭窄解除の治療効果は高く，積極的に検討すべきである．","PeriodicalId":19794,"journal":{"name":"Pediatric Cardiology and Cardiac Surgery","volume":"104 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136019632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

日本の少子化問題日本的少子化问题

Pediatric Cardiology and Cardiac Surgery Pub Date : 2023-02-01 DOI: 10.9794/jspccs.39.1

Ryuji Fukazawa

引用次数: 0

大動脈縮窄術後再狭窄および大動脈弁閉鎖不全症に対して側開胸を併施した正中アプローチによる再手術の1例针对主动脉缩窄术后再狭窄和主动脉瓣闭锁不全症实施侧开胸的正中接近术再次手术1例

Pediatric Cardiology and Cardiac Surgery Pub Date : 2023-02-01 DOI: 10.9794/jspccs.39.31

Satoshi Matsuo, Kota Itagaki, Masayuki Otani, Yusuke Suzuki, Shintaro Katahira, Takehiko Onoki, Chiharu Ota, Shinya Iwasawa, Yoshikatsu Saiki

{"title":"大動脈縮窄術後再狭窄および大動脈弁閉鎖不全症に対して側開胸を併施した正中アプローチによる再手術の1例","authors":"Satoshi Matsuo, Kota Itagaki, Masayuki Otani, Yusuke Suzuki, Shintaro Katahira, Takehiko Onoki, Chiharu Ota, Shinya Iwasawa, Yoshikatsu Saiki","doi":"10.9794/jspccs.39.31","DOIUrl":"https://doi.org/10.9794/jspccs.39.31","url":null,"abstract":"症例は12歳の男児で，出生後，大動脈縮窄症，心室中隔欠損症と診断され，生後1か月時に左側開胸にて拡大大動脈弓吻合法による手術が施行された．術後再狭窄を認め，バルーン血管形成術を5か月，3歳時に施行された．11歳時の精査で全長4 cmにわたる最小径5 mm, 圧較差50 mmHgに狭窄が進行した．また，大動脈弁逆流の進行も認めた．再手術に伴う大動脈周囲の高度な癒着，選択的脳分離体外循環の確立，大動脈弁閉鎖不全症と心室中隔欠損に対する外科的治療，これらの要素から胸骨正中切開と左前側方開胸を用いた下行大動脈人工血管置換，大動脈弁置換，心室中隔欠損閉鎖術を施行した．術後の上下肢圧較差は消失した．胸骨正中切開および左開胸アプローチは手術侵襲が大きいものの，安全に選択的脳分離体外循環を確立でき，解剖学的修復という観点から大動脈縮窄の根治性が高く，また心内修復も併施可能な手法である．","PeriodicalId":19794,"journal":{"name":"Pediatric Cardiology and Cardiac Surgery","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136019630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Treatment for Recurrent Coarctation 复发性缩窄的治疗

Pediatric Cardiology and Cardiac Surgery Pub Date : 2023-02-01 DOI: 10.9794/jspccs.39.37

Takeshi Shinkawa

引用次数: 0

Milrinone Re-Dilates the Ductus Arteriosus in Patients with Ductus Arteriosus-Dependent Congenital Heart Diseases 米立酮对动脉导管依赖性先天性心脏病患者动脉导管的再扩张作用

Pediatric Cardiology and Cardiac Surgery Pub Date : 2023-02-01 DOI: 10.9794/jspccs.39.25

Fumiaki Fukumura, Shiro Baba, Eitaro Kume, Koichi Matsuda, Kentaro Akagi, Takuya Hirata, Kazushi Yasuda, Junko Takita

{"title":"Milrinone Re-Dilates the Ductus Arteriosus in Patients with Ductus Arteriosus-Dependent Congenital Heart Diseases","authors":"Fumiaki Fukumura, Shiro Baba, Eitaro Kume, Koichi Matsuda, Kentaro Akagi, Takuya Hirata, Kazushi Yasuda, Junko Takita","doi":"10.9794/jspccs.39.25","DOIUrl":"https://doi.org/10.9794/jspccs.39.25","url":null,"abstract":"動脈管依存性先天性心疾患にとって動脈管開存は生存に必須であるが，経過中に動脈管が狭小化する症例が存在する．今回我々は，PGE1製剤投与中に狭小化した動脈管がミルリノン投与後に再開大した左心低形成症候群（HLHS）と重症肺動脈弁狭窄（cPS）の症例を経験した．HLHS症例は両側肺動脈絞扼術を施行され，Norwood術待機中に動脈管が狭小化した．lipo-PGE1からCD-PGE1に変更，投与量を増量されたが動脈管は開大せず，ミルリノンを開始後0.2 µg/kg/minまで増量された．cPS症例は，経皮的バルーン肺動脈弁形成術（PTPV）待機中に動脈管が狭小化した．lipo-PGE1からCD-PGE1に変更，投与量を増量されたが動脈管は開大せず，ミルリノンを開始後0.4 µg/kg/minまで増量された．いずれもミルリノン開始後，速やかに動脈管は再開大した．動脈管依存性先天性心疾患では動脈管狭小化時に速やかな治療が必要であるが，我々が経験した2症例においてはミルリノン投与が著効した．その作用機序について考察を加え報告する．","PeriodicalId":19794,"journal":{"name":"Pediatric Cardiology and Cardiac Surgery","volume":"267 1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135202202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

New Aorta-To-Right Ventricle Shunt Strategy for Pulmonary Atresia with Intact Ventricular Septum and Aortocoronary Atresia: Evaluation by Monitoring Sinusoidal Communication Flow 肺动脉闭锁伴完整室间隔和主动脉瓣闭锁的主动脉-右心室分流新策略：通过监测窦状交通流进行评估

Pediatric Cardiology and Cardiac Surgery Pub Date : 2020-03-01 DOI: 10.9794/jspccs.36.72

Kimihiro Yoshii, Jun Sato, Atsuko Kato, S. Yoshida, S. Takeda, H. Nisikawa, T. Osawa, T. Sakurai, T. Nonaka, H. Sakurai, N. Ohashi

{"title":"New Aorta-To-Right Ventricle Shunt Strategy for Pulmonary Atresia with Intact Ventricular Septum and Aortocoronary Atresia: Evaluation by Monitoring Sinusoidal Communication Flow","authors":"Kimihiro Yoshii, Jun Sato, Atsuko Kato, S. Yoshida, S. Takeda, H. Nisikawa, T. Osawa, T. Sakurai, T. Nonaka, H. Sakurai, N. Ohashi","doi":"10.9794/jspccs.36.72","DOIUrl":"https://doi.org/10.9794/jspccs.36.72","url":null,"abstract":"We describe a male infant who was diagnosed in utero with pulmonary atresia and an intact ventricular septum (PA-IVS) and diagnosed with aortocoronary atresia (ACA) by cardiac catheterization after birth. He was deliv-ered at full term and appeared normal for gestational age. Electrocardiography findings on day 3 of life showed ST depression while crying, and right ventricle-dependent coronary circulation (RVDCC) was suspected. Cardiac catheterization findings confirmed PA-IVS and ACA. We evaluated the blood flow of sinusoidal communication (SC) during the clinical course using pulsed-wave Doppler echocardiography. He underwent a Blalock ‒ Taussig shunt and an ascending aorta-to-right ventricle shunt (Ao-RV shunt) on day 41 of life. At the time of delivery, SC flow was antegrade from the right ventricle (RV) to the intramyocardium at systole and retrograde from the intramyocardium to the RV at diastole. Antegrade SC flow became biphasic after the Ao-RV shunt and increased at end-diastole. Furthermore, the increased oxygenation of SC blood due to the Ao-RV shunt helped to improve the coronary circulation. This novel Ao-RV shunt approach is suitable for treating PA-IVS and ACA.","PeriodicalId":19794,"journal":{"name":"Pediatric Cardiology and Cardiac Surgery","volume":"27 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141226609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0