心房中隔欠損症に対するAMPLATZERTM Septal Occluder留置後の心房細動に対し，中隔穿刺アプローチで安全に肺静脈隔離アブレーションに成功した1例
症例は63歳の女性．2009年より呼吸困難が出現し，その原因として心房中隔欠損症（ASD）が考えられた．2011年（当時59歳）に症状が悪化し二次孔欠損型ASDであったため，外科手術ではなくカテーテル治療のAMPLATZERTM Septal Occluderを用いた閉鎖術が行われた．以後自覚症状なく良好に経過していたが，2014年頃より動悸を自覚するようになり，近医で心房細動（AF）の診断を受けた．その後も月1回以上発作が出現したため，2015年に心房細動アブレーション（肺静脈隔離術：PVI）が施行された．肺動脈造影にて左房・肺静脈の解剖学的位置関係を確認し，心腔内エコー（AcuNav）下に...
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| Published in | Shinzo Vol. 48; no. SUPPL.2; pp. S2_36 - S2_42 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
公益財団法人 日本心臓財団
30.12.2016
Japan Heart Foundation |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo.48.S2_36 |
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| Abstract | 症例は63歳の女性．2009年より呼吸困難が出現し，その原因として心房中隔欠損症（ASD）が考えられた．2011年（当時59歳）に症状が悪化し二次孔欠損型ASDであったため，外科手術ではなくカテーテル治療のAMPLATZERTM Septal Occluderを用いた閉鎖術が行われた．以後自覚症状なく良好に経過していたが，2014年頃より動悸を自覚するようになり，近医で心房細動（AF）の診断を受けた．その後も月1回以上発作が出現したため，2015年に心房細動アブレーション（肺静脈隔離術：PVI）が施行された．肺動脈造影にて左房・肺静脈の解剖学的位置関係を確認し，心腔内エコー（AcuNav）下にAMPLATZERTMの後方下縁卵円窩を狙い，心房中隔穿刺に成功した．1回穿刺，2シースにて型通り両側PVIを行った．最後に，肺動脈造影を再度行い，僅かな左右シャントを確認し終了とした．本邦ではAFを合併したAMPLATZERTM留置症例に対する心房中隔穿刺の報告は少なく，安全にPVIを施行しその後の経過も良好のため報告する． |
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| AbstractList | 症例は63歳の女性．2009年より呼吸困難が出現し，その原因として心房中隔欠損症（ASD）が考えられた．2011年（当時59歳）に症状が悪化し二次孔欠損型ASDであったため，外科手術ではなくカテーテル治療のAMPLATZERTM Septal Occluderを用いた閉鎖術が行われた．以後自覚症状なく良好に経過していたが，2014年頃より動悸を自覚するようになり，近医で心房細動（AF）の診断を受けた．その後も月1回以上発作が出現したため，2015年に心房細動アブレーション（肺静脈隔離術：PVI）が施行された．肺動脈造影にて左房・肺静脈の解剖学的位置関係を確認し，心腔内エコー（AcuNav）下にAMPLATZERTMの後方下縁卵円窩を狙い，心房中隔穿刺に成功した．1回穿刺，2シースにて型通り両側PVIを行った．最後に，肺動脈造影を再度行い，僅かな左右シャントを確認し終了とした．本邦ではAFを合併したAMPLATZERTM留置症例に対する心房中隔穿刺の報告は少なく，安全にPVIを施行しその後の経過も良好のため報告する． |
| Author | 小池, 秀樹 小林, 建三郎 湯澤, ひとみ 福永, 俊二 篠原, 正哉 池田, 隆徳 藤野, 紀之 鈴木, 健也 |
| Author_FL | Koike Hideki Suzuki Takeya Shinohara Masaya Yuzawa Hitomi Fujino Tadashi Fukunaga Shunji Kobayashi Kenzaburo Ikeda Takanori |
| Author_FL_xml | – sequence: 1 fullname: Yuzawa Hitomi – sequence: 2 fullname: Fujino Tadashi – sequence: 3 fullname: Shinohara Masaya – sequence: 4 fullname: Koike Hideki – sequence: 5 fullname: Suzuki Takeya – sequence: 6 fullname: Fukunaga Shunji – sequence: 7 fullname: Kobayashi Kenzaburo – sequence: 8 fullname: Ikeda Takanori |
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| DocumentTitleAlternate | A Safety and Successful Ablation for Atrial fibrillation with Atrial Septal Defect after Atrial Septal Occlusion by AMPLATZERTM Septal Occluder |
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| References | 12 Santangeli P, Di Biase L, Burkhardt JD, et al：Transseptal access and atrial fibrillation ablation guided by intracardiac echocardiography in patients with atrial septal closure devices. Heart Rhythm 2011；8：1669-1675 11 Murphy JG, Gersh BJ, McGoon MD, et al：Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years. N Engl J Med 1990；323：1645-1650 18 Anselmino M, Scaglione M, Battaglia A, et al：Iatrogenic atrial septal defects following atrial fibrillation transcatheter ablation：a relevant entity? Europace 2014；16：1562-1568 13 Chan NY, Choy CC, Lau CL, et al：Persistent iatrogenic atrial septal defect after pulmonary vein isolation by cryoballoon：an under-recognized complication. Europace 2011；13：1406-1410 10 Vecht JA, Saso S, Rao C, et al：Atrial septal defect closure is associated with a reduced prevalence of atrial tachyarrhythmia in the short to medium term：a systematic review and meta-analysis. Heart 2010；96：1789-1797 4 Berger F, Vogel M, Kramer A, et al：Incidence of atrial flutter／fibrillation in adults with atrial septal defect before and after surgery. Ann Thorac Surg 1999；68：75-78 8 Szkutnik M, Lenarczyk A, Kusa J, Białkowski J：Symptomatic tachy- and bradyarrhythmias after transcatheter closure of interatrial communications with Amplatzer devices. Cardiol J 2008；15：510-516 6 Crandall MA, Daoud EG, Daniels CJ, Kalbfleisch SJ：Percutaneous radiofrequency catheter ablation for atrial fibrillation prior to atrial septal defect closure. J Cardiovasc Electrophysiol 2012；23：102-104 1 循環器学会 成人先天性心疾患診療ガイドライン 2011年改訂版 19 Aznaouridis K, Hobson N, Rigg C, Bragadeesh T. Emergency Percutaneous Closure of an Iatrogenic Atrial Septal Defect Causing Right-to-Left Shunt and Severe Refractory Hypoxemia After Pulmonary Vein Isolation. JACC Cardiovasc Interv 2015；8：e179-181 2 中沢誠，瀬口正史，高尾篤良：わが国における新生児心疾患の発生状況（東京女子医科大学附属日本心臓血圧研究所）．日本小児科学会雑誌1986；90：2578-2587 5 Gatzoulis MA, Freeman MA, Siu SC, et al：Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med 1999；340：839-846 9 Spies C, Khandelwal A, Timmermanns I, Schräder R：Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults. Am J Cardiol 2008；102：902-906 17 Hammerstingl C, Lickfett L, Jeong KM, et al：Persistence of iatrogenic atrial septal defect after pulmonary vein isolation—an underestimated risk? Am Heart J 2006；152：362.e1-5. 14 Sieira J, Chierchia GB, Di Giovanni G, et al：One year incidence of iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2014；25：11-15 3 Chen L, Bai Y, Wang FY, et al：Transcatheter closure of atrial septal defects improves cardiac remodeling and function of adult patients with permanent atrial fibrillation. Chin Med J（Engl）2015；128：780-783 15 Obel O, Mansour M, Picard M, et al：Persistence of septal defects after transeptal puncture for pulmonary vein isolation procedures. Pacing Clin Electrophysiol 2004；27：1411-1414 16 Rillig A, Meyerfeldt U, Birkemeyer R, et al：Persistent iatrogenic atrial septal defect after pulmonary vein isolation：incidence and clinical implications. J Interv Card Electrophysiol 2008；22：177-181 7 Nyboe C, Olsen MS, Nielsen-Kudsk JE, Hjortdal VE：Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure. Heart 2015；101：706-711 |
| References_xml | – reference: 15 Obel O, Mansour M, Picard M, et al：Persistence of septal defects after transeptal puncture for pulmonary vein isolation procedures. Pacing Clin Electrophysiol 2004；27：1411-1414 – reference: 18 Anselmino M, Scaglione M, Battaglia A, et al：Iatrogenic atrial septal defects following atrial fibrillation transcatheter ablation：a relevant entity? Europace 2014；16：1562-1568 – reference: 5 Gatzoulis MA, Freeman MA, Siu SC, et al：Atrial arrhythmia after surgical closure of atrial septal defects in adults. N Engl J Med 1999；340：839-846 – reference: 9 Spies C, Khandelwal A, Timmermanns I, Schräder R：Incidence of atrial fibrillation following transcatheter closure of atrial septal defects in adults. Am J Cardiol 2008；102：902-906 – reference: 12 Santangeli P, Di Biase L, Burkhardt JD, et al：Transseptal access and atrial fibrillation ablation guided by intracardiac echocardiography in patients with atrial septal closure devices. Heart Rhythm 2011；8：1669-1675 – reference: 2 中沢誠，瀬口正史，高尾篤良：わが国における新生児心疾患の発生状況（東京女子医科大学附属日本心臓血圧研究所）．日本小児科学会雑誌1986；90：2578-2587 – reference: 4 Berger F, Vogel M, Kramer A, et al：Incidence of atrial flutter／fibrillation in adults with atrial septal defect before and after surgery. Ann Thorac Surg 1999；68：75-78 – reference: 10 Vecht JA, Saso S, Rao C, et al：Atrial septal defect closure is associated with a reduced prevalence of atrial tachyarrhythmia in the short to medium term：a systematic review and meta-analysis. Heart 2010；96：1789-1797 – reference: 11 Murphy JG, Gersh BJ, McGoon MD, et al：Long-term outcome after surgical repair of isolated atrial septal defect. Follow-up at 27 to 32 years. N Engl J Med 1990；323：1645-1650 – reference: 13 Chan NY, Choy CC, Lau CL, et al：Persistent iatrogenic atrial septal defect after pulmonary vein isolation by cryoballoon：an under-recognized complication. Europace 2011；13：1406-1410 – reference: 7 Nyboe C, Olsen MS, Nielsen-Kudsk JE, Hjortdal VE：Atrial fibrillation and stroke in adult patients with atrial septal defect and the long-term effect of closure. Heart 2015；101：706-711 – reference: 6 Crandall MA, Daoud EG, Daniels CJ, Kalbfleisch SJ：Percutaneous radiofrequency catheter ablation for atrial fibrillation prior to atrial septal defect closure. J Cardiovasc Electrophysiol 2012；23：102-104 – reference: 1 循環器学会 成人先天性心疾患診療ガイドライン 2011年改訂版 – reference: 16 Rillig A, Meyerfeldt U, Birkemeyer R, et al：Persistent iatrogenic atrial septal defect after pulmonary vein isolation：incidence and clinical implications. J Interv Card Electrophysiol 2008；22：177-181 – reference: 14 Sieira J, Chierchia GB, Di Giovanni G, et al：One year incidence of iatrogenic atrial septal defect after cryoballoon ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2014；25：11-15 – reference: 3 Chen L, Bai Y, Wang FY, et al：Transcatheter closure of atrial septal defects improves cardiac remodeling and function of adult patients with permanent atrial fibrillation. Chin Med J（Engl）2015；128：780-783 – reference: 19 Aznaouridis K, Hobson N, Rigg C, Bragadeesh T. Emergency Percutaneous Closure of an Iatrogenic Atrial Septal Defect Causing Right-to-Left Shunt and Severe Refractory Hypoxemia After Pulmonary Vein Isolation. JACC Cardiovasc Interv 2015；8：e179-181 – reference: 17 Hammerstingl C, Lickfett L, Jeong KM, et al：Persistence of iatrogenic atrial septal defect after pulmonary vein isolation—an underestimated risk? Am Heart J 2006；152：362.e1-5. – reference: 8 Szkutnik M, Lenarczyk A, Kusa J, Białkowski J：Symptomatic tachy- and bradyarrhythmias after transcatheter closure of interatrial communications with Amplatzer devices. Cardiol J 2008；15：510-516 |
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| Snippet | 症例は63歳の女性．2009年より呼吸困難が出現し，その原因として心房中隔欠損症（ASD）が考えられた．2011年（当時59歳）に症状が悪化し二次孔欠損型ASDであったため，外科手術ではなくカテーテル治療のAMPLATZERTM Septal... |
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| SubjectTerms | AMPLATZERTM カテーテルアブレーション 心房中隔欠損症 心房中隔穿刺 心房細動 |
| Title | 心房中隔欠損症に対するAMPLATZERTM Septal Occluder留置後の心房細動に対し，中隔穿刺アプローチで安全に肺静脈隔離アブレーションに成功した1例 |
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