<原著>External conduitおよびin situ valve insertionによる肺動脈再建術の遠隔期成績

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The postoperative long-term hemodynamics and cardiac functions were studied in the patients undergoing reconstruction of the right ventricular outflow tract using an external counduit and an in situ pulmonary valve insertion (ISPVI). As the substitute, 18 were mechanical valves, including one used in reoperation, and five tissue valves. The following results were obtained, that is, right ventricular to left ventricular systolic pressure ratio (P_<RV/LV>) (Y) in ECR or ISPVI was mainly regulated by effective valve area index (EVAI) (X), and a correlation expressed by the regression equation Y=0.43・X^2+0.32 (r=-0.571,p<0.05,n=19) was obtained. Hence, in order to obtain favorable hemodynamics of P_<RV/LV> of 0.5 or less after the operation, it is necessary that EVAI is 1.55 cm^2/m^2 or more. In the ECR group, P_<RV/LV> in a follow-up period averaging three years was 0.48 on the average, showing a relatively favorable reduction, and the left ventricular function was almost normal, but the right ventricular function was impaired. In the postoperative long-term results of ECR, the greatest factor for lowering the right ventricular function was the elevation of the right ventricular pressure, and between P_<RV/LV> (X) and RVEF (Y) a correlation was present, expressed by the regression equation Y=0.56-0.16・X (r=-0.68,p<0.05,n=11). Also, between RVEDV (X) and LVEDV (Y), there was a correlation, as expressed by the regression equation Y=7.80+0.99・X (r=0.87,p<0.05,n=8). Accordingly, the decrease of the right ventricular function due to the elevation of right ventricular pressure also 1ed to the enlargement of the left ventricle, which resulted in the decrease of left ventricular function. In the ISPVI group, the left ventricular function in the follow-up period of three years on the average indicated almost all in the normal range, while the right ventricular function was decreased. The postoperative long-term cardiac function in the patients undergoing the enlargement for central pulmonary stenosis (PS), simultaneously with the reconstruction was similar to that in the patients who had no complication preoperatively. In the pulmonary valve insertion with a mechanical valve, a complication including a thrombotic valve is likely to appear. In particular, in children less than eight years of age, a transient thrombotic valve was experienced in six of nine patients (66.7%). Thus, to prevent a thrombotic valve in the patients having mechanical valve, it is required to keep the thrombo test in the neighbour of 10%. In small children under eight years of age, it is preferable to use tissue valves.
近畿大学の論文
1987-03-25

<原著>External conduitおよびin situ valve insertionによる肺動脈再建術の遠隔期成績

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