<原著>Extracardiac conduit及びin situ valve insertionによる肺動脈再建術の検討

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The operative risk factors and the postoperative hemodynamic results were evaluated in 25 patients who underwent pulmonary artery reconstruction with a substitute valve. Seventeen extracardiac conduits containing a substitute valve were used in 16 patients and an in situ pulmonary valve insertion was done on 9. The patients ranged in age from 9 months to 54 years (mean 13.3 years). The average duration of the postoperative follow-up was 4.1 years in the survivors. The patients were classified into five diagnostic categories, that is, single ventricle 6,pulmonary atresia 6,transposition of the great arteries 3,tetralogy of Fallot 3,pulmonary valve absence syndrome 2 and others 5. Of 25 patients, 16 survived and 8 succumbed. Of 16 with extracardiac conduit repair, 7 were lost with a mortality rate of 43.8% and only one of 9 with an in situ valve insertion died. The surgical results were mainly influenced by complexity of the cardiac anomalies and status of the pulmonary arteries. The mortality rates were 66.7% in the patients with single ventricle, 33.3% in the pulmonary atresia patients, and 25% in the transposition patients and others, respectively. There was no death in tetralogy of Fallot and absent pulmonary valve syndrome. Of 9 with an immediate postrepair systolic pressure ratio of the pulmonary to systemic ventricle (Ppv/sv) over 0.75,7 patients were lost. In contrast, only one died in 17 with a Ppv/sv of less than 0.75. On the other hand, of 8 with valve area index (VAI) of less than 1.5 cm^2/M^2,5 succumbed, but 3 of 18 with VAI over 1.5 cm^2/M^2 were lost. Late death occurred in 2 patients and conduit re-replacement was done on one 8 years after the first conduit repair. Residual defects were detected in three, i. e., residual shunt in 2 and stenosis of the pulmonary bifurcation in one. The postoperative Ppv/sv was mainly regulated by VAI and a close correlation which is expressed by the following equation was obtained between them, that is, Ppv/sv=0.41/(VAI)^2+0.36 (r=-0.61,p<0.05). Thus, to obtain excellent hemodynamics with a Ppv/sv of less than 0.5,VAI (effective orifice area/BSA) should be over 1.7 cm^2/M^2 and to avoid re-replacement of the conduit after reaching adulthood, the diameter of the graft should be over 18 mm and the valve size be over 23A in SJM mechaniccal valve.
近畿大学の論文
1984-03-25

<原著>Extracardiac conduit及びin situ valve insertionによる肺動脈再建術の検討

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