一般口演1-04（II-OR104）
胎児心臓病学2

[II-OR104-04] 母体酸素投与により緊急BASを回避し得た卵円孔早期閉鎖合併僧帽弁狭窄の症例

^○中矢代 真美, 高橋 一浩, 鍋嶋 泰典 (沖縄県立南部医療センター・こども医療センター)

Keywords:胎児治療、左心低形成、周産期管理

[Prenatal course]The case was initially diagnosed with coarctation of the aorta and VSD at GA 29week. However, at 30 week, impending premature closure of the foramen ovale was suspected, which was followed with progressive mitral stenosis, leading to progressive left ventricular hypoplasty. The mother then was admitted due to developed premature labor. The feasibility of high risk surgical atrioseptostomy in case of premature birth was discussed among the pediatric cardiovascular team.Oxygen supplementation to the mother was started with informed consent to investigate the response of the fetal pulmonary vascular flow. The VTI was increased after oxygen, suggesting increased pulmonary blood flow. Intermittent oxygen supplement was continued during pregnancy, with routine echo to check fetal cardiac parameters and patency of the ductus arteriosus. The mitral valve stenosis was gradually ameliorated and the patency of the DA was maintained. [Postnatal course]The baby was born prematurely at GA 34w 5d BW 2908g but although the atrial septum was restrictive and borderline hypoplastic left ventricle, there was enough mitral valve forward flow to avoid emergency atrioseptostomy. The baby was initiated on prostaglandin E1 to maintain the ductus arteriosus and was able to achieve growth and maturity. Bilateral PA banding and atrioseptectomy was performed at 5 weeks of age. [Discussion]The case is suggests the possibility of some growth in the mitral valve in cases with premature closure of the foramen ovale with a relatively noninvasive prenatal maternal oxygen supplement.