ID | 61769 |
フルテキストURL | |
著者 |
Kanai, Anna
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
Koitabashi, Norimichi
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
Akagi, Satoshi
Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
ORCID
Kaken ID
Sorimachi, Hidemi
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
Ishibashi, Yohei
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
Nagasaka, Takashi
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
Takama, Noriaki
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
Soma, Katsura
Department of Cardiovascular Medicine, The University of Tokyo Hospital
Yao, Atsushi
Department of Cardiovascular Medicine, The University of Tokyo Hospital
Kasahara, Shingo
Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Kaken ID
publons
Kurabayashi, Masahiko
Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
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抄録 | We report a case of ventricular septal defect (VSD) in which we attempted to treat pulmonary arterial hypertension (PAH) with the goal of VSD closure in an adult with suspected Eisenmenger syndrome in childhood. Four years previously (age 41 years), she was referred to our department due to repeated hemoptysis requiring further treatment of PAH. We started combination therapy with several pulmonary vasodilators. Two years later, her pulmonary vascular resistance (PVR) was improved but still not at the level where VSD closure was possible. To control the increased PA flow resulting from intensive PAH treatment and to reduce the risk of hemoptysis, we performed pulmonary artery banding (PAB). As the risk of hemoptysis decreased, a prostacyclin analog was introduced, and the dose was increased. More than 1 year after PAB, active vasoactivity testing became positive, suggesting that the pulmonary vascular lesion was now “reversible”. We performed VSD closure and atrial septal defect creation even though her PVR was still high. After the operation, her exercise capacity was remarkably improved. We suggest that stepwise surgical repair with pulmonary vasodilators is an important treatment option for select patients with VSD with severe PAH.Learning objectiveAdvances in pulmonary arterial hypertension (PAH) treatment have led to the use of a “treat-and-repair” strategy to close the intracardiac shunt after PAH treatment in select patients with adult congenital heart disease. In our case, ventricular septal defect (VSD) closure was achieved with stepwise surgical repair and a combination of pulmonary vasodilators, even though long-standing severe PAH with persistent hemoptysis remained. Even after a long period of exposure to high blood flow, this strategy may reduce pulmonary vascular resistance and permit eventual closure of the VSD.
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キーワード | Pulmonary arterial hypertension
Ventricular septal defect
Treat-and-repair strategy
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発行日 | 2021-03-09
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出版物タイトル |
Journal of Cardiology Cases
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出版者 | Elsevier
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ISSN | 18785409
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資料タイプ |
学術雑誌論文
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言語 |
英語
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OAI-PMH Set |
岡山大学
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著作権者 | © 2021 Japanese College of Cardiology.
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論文のバージョン | publisher
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DOI | |
関連URL | isVersionOf https://doi.org/10.1016/j.jccase.2021.02.013
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ライセンス | http://creativecommons.org/licenses/by-nc-nd/4.0/
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Citation | Anna Kanai, Norimichi Koitabashi, Satoshi Akagi, Hidemi Sorimachi, Yohei Ishibashi, Takashi Nagasaka, Noriaki Takama, Katsura Soma, Atsushi Yao, Shingo Kasahara, Masahiko Kurabayashi, A case of a middle-aged patient with a ventricular septal defect complicated by severe pulmonary hypertension-stepwise surgical repair with pulmonary vasodilators-, Journal of Cardiology Cases, 2021, , ISSN 1878-5409, https://doi.org/10.1016/j.jccase.2021.02.013.
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オープンアクセス(出版社) |
OA
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オープンアーカイブ(出版社) |
非OpenArchive
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