Fontan手術後の脊柱側弯症に対し後方矯正固定術を施行した1例

Spinal Posterior Correction and Fusion Surgery after a Fontan Operation. Case Report

　先天性心疾患に伴うチアノーゼに対する機能的修復術であるFontan手術の既往がある患者では，人工呼吸器管理中に静脈還流が低下する可能性があるため，大量出血を伴う手術は困難とされてきた．今回われわれは，Fontan手術歴のある17歳の脊柱側弯症患者に対し後方矯正固定術を行い，良好な術後経過が得られた．周術期の心不全予防のため，術中循環動態モニタリング，利尿剤投与などの適切な周術期管理が有効であった．

　In Fontan operation the superior and inferior venae cavae are combined into a pulmonary artery to restore function in congenital heart anomalies.　Since venous blood then flows directly into the pulmonary artery, positive-pressure ventilation decreases cardiac output and pulmonary blood flow.　Thus, spinal surgery, which is accompanied by massive blood loss, has been considered to be difficult.　We report the case of a 17-year-old woman with progressive scoliosis who had undergone Fontan operation and was successfully treated by posterior correction and fusion surgery.　Intensive circulatory monitoring and appropriate administration of the drugs furosemide, spironolactone, and sildenafil made it possible to perform the posterior correction surgery for scoliosis without serious complications.