Japanese
Title体外循環中に心外膜心電図を用いて管理した右室依存性冠動脈を合併した肺動脈閉鎖の一例
Subtitle症例
Authors平松謙二*1, 木内恵子*1, 澤竹正治*1, 北村征治*1, 岸本英文*2, 川田博昭*2, 上野高義*2
Authors(kana)
Organization*1大阪府立母子保健総合医療センター麻酔科, *2大阪府立母子保健総合医療センター心臓血管外科
Journal循環制御
Volume18
Number2
Page264-267
Year/Month1997/
Article報告
Publisher日本循環制御医学会
Abstract「要旨」冠動脈左前下行枝の血流が右室に依存する純型肺動脈閉鎖(以下PAIVS)の症例に対する上大静脈-肺動脈吻合術の麻酔を経験したので報告する. 症例は, 1歳11ヵ月の男児で生後21日目に左Blalock-Taussigシャント手術が施行されたが, チアノーゼが進行してきたため, 今回の手術となった. 完全体外循環開始による右室減圧により, 心筋虚血を起こす可能性があるため, 左前下行枝領域に術野より電極を設置し, 心外膜心電図をモニターした. 体外循環は上大静脈から脱血し, 下大静脈からは脱血せず自己心拍下に部分体外循環を行い, 右室圧を維持した. この時心外膜心電図に変化は認めなかった. その後, 上大静脈-肺動脈吻合術後, 体外循環離脱前に試験的に上下大静脈からの脱血を行い, 心外膜心電図を記録したところ, ST低下を認めたため, 本症例は右室減圧に伴い心筋虚血を起こすことが確認された.
Practice基礎医学・関連科学
KeywordsRight ventricle-dependent coronary artery, Pulmonary atresia, Epicardial ECG, Cardiopulmonary bypass
English
TitleEpicardial ECG Monitoring during Cardiopulmonary Bypass in an Infant with RV -dependent Coronary Circulation
Subtitle
AuthorsKenji Hiramatsu*1, Keiko Kinouchi*1, Masahiro Sawatake*1, Seiji Kitamura*1, Hidefumi Kishimoto*2, Hiroaki Kawata*2, Takayosi Ueno*2
Authors(kana)
Organization*1Department of Anesthesiology, Osaka Medical Center and Research Institute for Maternal and Child Health, *2Department of Cardiovascular Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health
JournalCirculation Control
Volume18
Number2
Page264-267
Year/Month1997/
ArticleReport
PublisherJapan Society of Circulation Control
AbstractWe report the efficacy of an epicardial ECG monitoring to detect myocardial ischemia in a patient with a right ventricle-dependent coronary circulation, He was a 23-month-old male infant who had pulmonary atresia with intact ventricular septum diagnosed by fetal echocardiogram. He underwent left Blalock-Taussig shunt operation at 21 days of life. For the progress of cyanosis he was scheduled for a cavopulmonary shunt procedure. Cardiac catheterization confirmed the above diagnosis and the right ventricle-dependent left anterior descending coronary artery. For fear of left coronary insufficiency, the operation was performed under partial cardiopulmonary bypass (CPB) with the heart beating and without the RV decompression. Through-out the procedure an epicardial ECG was monitored. After the completion of the cavopulmonary anastomosis, total CPB with venous drainnage from the inferior vena cava was attempted in order to evaluate the safety of RV decompression required for Fontan operation in the future. Soon after the RV decompression, the epicardial ECG showed an ST segment depression. Venous drainage from the inferior vena cava was discontinued and the ST change in the epicardial ECG slowly returned to normal. Weaning from the CPB was smooth. Pulmonary atresia with intact ventricular septum is often associated with an abnormal coronary circulation. The caution should be taken to detect the perioperative myocardial ischemia.
PracticeBasic medicine
KeywordsRight ventricle-dependent coronary artery, Pulmonary atresia, Epicardial ECG, Cardiopulmonary bypass

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