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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
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.
キーワード
Pulmonary arterial hypertension
Ventricular septal defect
Treat-and-repair strategy
発行日
2021-03-09
出版物タイトル
Journal of Cardiology Cases
出版者
Elsevier
ISSN
18785409
資料タイプ
学術雑誌論文
言語
English
OAI-PMH Set
岡山大学
著作権者
© 2021 Japanese College of Cardiology.
論文のバージョン
publisher
DOI
関連URL
isVersionOf https://doi.org/10.1016/j.jccase.2021.02.013
ライセンス
http://creativecommons.org/licenses/by-nc-nd/4.0/
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.
オープンアクセス(出版社)
OA
オープンアーカイブ(出版社)
非OpenArchive