循環器ジャーナル68巻2号

2020年04月発行

特集 心エコー図で何を見る？—スクリーニングから精査まで Ⅴ．病棟編—精査とその解釈のために

—先天性心疾患（Ⅰ）—心房中隔欠損症（ASD），卵円孔開存（PFO），心室中隔欠損症（VSD）

著者： 高谷陽一¹

所属機関： ¹岡山大学循環器内科

ページ範囲：P.353 - P.361

Point
・ASDはカテーテル閉鎖術が第一選択であり，欠損孔の評価が重要である．
・PFOは奇異性脳塞栓症の再発予防にカテーテル閉鎖術の有効性が示され，診断が重要になっている．
・VSDは成人期では小欠損孔が多く，肺高血圧症や大動脈弁逸脱など合併症に注意する．

参考文献

1) Kijima Y, Akagi T, Takaya Y, et al:Treat and repair strategy in patients with atrial septal defect and significant pulmonary arterial hypertension. Circ J 80:227-234, 2016

2) Takaya Y, Akagi T, Kijima Y, et al:Functional tricuspid regurgitation after transcatheter closure of atrial septal defect in adult patients:long-term follow-up. JACC Cardiovasc Interv 10:2211-2218, 2017

3) Takaya Y, Kijima Y, Akagi T, et al:Fate of mitral regurgitation after transcatheter closure of atrial septal defect in adults. Am J Cardiol 116:458-462, 2015

4) Takaya Y, Akagi T, Kijima Y, et al:Echocardiographic estimates of left ventricular diastolic dysfunction do not predict the clinical course in elderly patients undergoing transcatheter atrial septal defect closure:impact of early diastolic mitral annular velocity. J Interv Cardiol 30:79-84, 2017

5) Nakagawa K, Akagi T, Taniguchi M, et al:Transcatheter closure of atrial septal defect in a geriatric population. Catheter Cardiovasc Interv 80:84-90, 2012

6) Takaya Y, Akagi T, Kijima Y, et al:Long-term outcome after transcatheter closure of atrial septal defect in older patients:impact of age at procedure. JACC Cardiovasc Interv 8:600-606, 2015

7) Baumgartner H, Bonhoeffer P, De Groot NM, et al:ESC Guidelines for the management of grown-up congenital heart disease（new version 2010）. Eur Heart J 31:2915-2957, 2010

8) 日本循環器学会：2014年版先天性心疾患，心臓大血管の構造的疾患（structural heart disease）に対するカテーテル治療のガイドライン．2014

9) Ueno Y, Iguchi Y, Inoue T, et al:Paradoxical brain embolism may not be uncommon-prospective study in acute ischemic stroke. J Neurol 254:763-766, 2007

10) Saver JL, Carroll JD, Thaler DE, et al:Long-term outcomes of patent foramen ovale closure or medical therapy after stroke. N Engl J Med 377:1022-1032, 2017

11) Sondergaard L, Kasner SE, Rhodes JF, et al:Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med 377:1033-1042, 2017

12) Mas JL, Derumeaux G, Guillon B, et al:Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med 377:1011-1021, 2017

13) Johansson MC, Eriksson P, Guron CW, et al:Pitfalls in diagnosing PFO:characteristics of false-negative contrast injections during transesophageal echocardiography in patients with patent foramen ovales. J Am Soc Echocardiogr 23:1136-1142, 2010

14) Nakayama R, Takaya Y, Akagi T, et al:Identification of high-risk patent foramen ovale associated with cryptogenic stroke:development of a scoring system. J Am Soc Echocardiogr 32:811-816, 2019

15) 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）．2018