動脈管結紮後に進行した乳児期大動脈縮窄複合の1例

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  • Manifestation of Coarctation After Surgical Ligation of Persistent Ductus Arteriosus in Infancy : A Case Report

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An 8-day-old female baby, weighing 2690gr, was admitted for heart failure with the diagnosis of large VSD, ASD, PDA, and mild CoA. On the 18th day after birth, she underwent PDA ligation and pulmonary artery banding, but CoA with a pressure gradient of ISmmHg was not treated surgically. Because of intractable heart failure. PAB was again reinforced on the 64th day after birth. After the second operation, heart failure improved but recurrent pulmonary infection persisted. At 4-months of age, a pressure gradient between upper and lower extremities became apparent. Cardiac catheterization revealed a pressure gradient of 38mmHg at the site of coarctation, and it was dilated with a balloon catheter. But recurrent pulmonary infection and atelectasis persisted even after balloon angioplasty. At 9-months of age, the residual CoA was surgically repaired usinug the subclavian artery flap method. Five days after CoA repair, intracardiac repair, including patch closure of VSD (20mm in diameter) , direct closure of ASD (5mm in diameter), and patch angioplasty of the pulmonary trunk after the removal of banding tape, was completed. Cardiac catheterization one year after the final procedure revealed favoable results. In this patient, CoA had been evaluated as insignificant and not treated in newborn period. Follwing PDA ligation and PAB, CoA had gradually developed in severity and multiple and complicated treatments were required because of a large left-to-right shunt.

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