13. 呼吸器や消化器合併奇形を有する先天性心疾患と周術期管理

Congenital Heart Surgery in Patients with Coexisting Congenital Anomalies of Respiratory or Digestive System

気管や食道の狭窄・閉塞性疾患は心疾患の周術期管理において生命を脅かしうる合併症であり，それぞれの治療時期や方法に関しては長期的な戦略を立てることが重要である．しかし，多様な先天性心疾患と呼吸器・消化器合併症の組み合わせが，その治療方針を一概に論じることをむずかしくしており，これまでも個別に検討されてきた経緯がある．本稿では，主な呼吸器および消化器疾患を合併した先天性心疾患とその周術期の管理について，文献的考察ならびに当院での経験を加えて解説する．

Congenital anomaly of respiratory or digestive system have a significant impact on the perioperative management of congenital heart disease. Therefore, it is important to make a long-term treatment strategy. It has been reported that 1-stage surgery is effective for pulmonary artery sling. Simultaneous repair is also useful if significant airway stenosis is present prior to cardiac surgery. In the case of congenital heart disease associated with gastrointestinal anomaly, gastrointestinal surgery precedes in more than 80％ of cases. In recent years, though treatments of gastrointestinal atresia have a good outcome, the results of esophageal atresia are still bad. If we choice multi-stage surgery, there is a possibility that we cannot perform cardiac surgery at appropriate time due to postoperative mediastinitis. Therefore, we must consider the timing and method of operation individually. The important thing is to keep a good relationships with related departments and to provide close informed consent to the patient’s parents.