Fallot四徴症術後遠隔期手術

Surgical Management of the Patients with Tetralogy of Fallot；Long-term after Initial Repair

Fallot四徴症はもっとも頻度の高いチアノーゼ性心疾患である．現在，本邦においてFallot四徴症の心内修復術は年間300～400例程度行われており，入院死亡率は2％前後である1～3）．1996年時点でのFallot四徴症の死亡率は約5％程度であり4），死亡率はここ20年で半分以下に低下している．このため，今後ますます成人のFallot四徴症患者は増加していくことが考えられる．術後遠隔期に問題となるのは，①肺動脈弁逆流に伴う右室拡大，右室機能不全，②右室流出路狭窄，肺動脈分岐狭窄，③三尖弁逆流，④不整脈（上室性・心室性），⑤大動脈拡張などである．

Almost 90％ of children with congenital heart disease now reach adulthood due to the improved results of cardiac surgery and medical treatment. Among them, one of particular problems is pulmonary valve regurgitation after tetralogy of Fallot repair. About 20 years ago （1996）, the mortality of tetralogy of Fallot has already been relatively good at about 5％, but now it is further reduced to about 2％. For this reason, it is conceivable that more and more adult patients with tetralogy of Fallot will increase in the future. Pulmonary valve regurgitation is often caused by the use of transannular patch repair. Surgical indications for pulmonary valve regurgitation include those with decreased exercise tolerance, right ventricular dysfunction, advanced right ventricular enlargement. We examined treatment strategies, valve selection and catheter valve implantation.