極低出生体重児の大動脈縮窄症に対して経皮的大動脈バルーン拡張術後に外科治療を行った1例

Abstract

For infants with coarctation of the aorta (COA), either transcatheter balloon angioplasty (BA) or surgical repair is used. COA recurs frequently in low-birth-weight infants who have had either BA or surgical repair. We present a case of a baby girl born at 35 weeks gestational age and weighing 1,374 g who underwent successful surgical repair of COA following palliative BA. A systemic blood pressure gradient of 64 mmHg between the upper and lower limbs was observed at the age of 6 days, con rming the diagnosis of COA. At the age of 25 days, we conducted BA for COA with a minimum diameter of 1.3 mm. Following the placement of a 3-French sheath in the femoral artery, we performed a predilatation with a coronary angioplasty balloon (NC TREK ® 2 mm) and a second dilatation with a valvuloplasty balloon (TMP-PED ® 4 mm). e systemic blood pressure di erence between the upper and lower limbs was reduced to 9 mmHg a er successful dilation. As a recurrence of COA developed along with body weight gain, coarctation resection and extended end-to-end anastomosis were performed at the age of 108 days and weight of 3,050 g. At the age of 7 months, there was no recurrence of COA. We believe that delayed surgical repair a er palliative BA may be possible in low-birth-weight infants with COA to avoid recurrence of COA.