乳児期肺動静脈瘻の1例—カテーテル治療と非侵襲的検査法

Successful Coil Embolization for Pulmonary Arteriovenous Fistula in Infancy: Case report

　新生児期にチアノーゼを主訴に発見された肺動静脈瘻の1例を報告した．月齢7で13個のGianturco coilを使用し塞栓術を施行，完全閉塞を得た．動脈血酸素飽和度は88％から97％にまで上昇した．術前にCT検査，MRI検査などを施行したが，異常血管の肺内構造，動静脈瘻分布領域の評価が可能で，カテーテル塞栓術の術前検査として非常に有用であった．

　A one-day-old female child was referred to our hospital because of cyanosis. The percutaneous O₂ saturation was 70%. Chest X-ray film showed cardiac enlargement with a cardiothoracic ratio of 0.60 and an opacity apparent in the right lower lobe.

　A diagnostic echocardiography demonstrated an enlarged right pulmonary artery and vein, without other cardiac anomalies, thus suggesting the existence of a pulmonary arteriovenous fistula. Additional noninvasive imaging study (CT and MRI), confirmed the diagnosis and identified the segmental location of the lesion in the lung. We occluded the arteriovenous fistula with 13 Gianturco coils and achieved complete occlusion, with the improvement of arterial O₂, saturation from 80% to 97%.

　Transcatheter embolization is the procedure of first choice, and the noninvasive imaging study such as CT and MRI is useful for creating an intrapulmonary image of PAVF and for facilitating transcatheter embolization.