Atrioventricular Discordance を伴う心奇型の手術,遠隔成績と残遺病変

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Surgical experiences with 25 patients who had congenital heart disease associated with both atrioventricular and arterioventricular discordance were reviewed. Total correction was performed in 22 of 25 patients. The main factors deteriorationg the surgical results were surgically induced complete heart block(CHB), anatomical(systemic)tricuspid regurgitation(TR), myocardial failure, iatrogenic aortic regurgitation(AR) following aortotomy approach to ventricular septal defects(VSD), arrhythmias and residual pulmonary stenosis (PS). The CHB occurred frequently when the VSD was approached through the anatomical left ventricle. Myocardial failure resulting in chronic heart failure observed in 3 patients was secondary to systemic right ventriculotomy for VSD closure. A low grade of AR resulted from traumatic retraction of the aortic valve for VSD closure through aortotomy, but this could be eliminated. PS should be relieved by means of an extracardiac conduit unless it is relieved by pulmonic valvotomy only. While in small children, significant PS should be treated by a palliative procedure. TR was also a major abnomality in this disease, which was noted in 44% of our patients. TR was severe in some children with Ebstein-type anomaly of the tricuspid valve and in others, TR deteriorated after surgery with right ventriculotomy approach. TR was one of the main factors compromizing the postoperative status. Right ventriculotomy is a good approach for the prevention of CHB, but can not be recommended as far as the late results are concerned, since deterioration of TR and myocardial failure may appear more frequently in the late postoperative period.
日本小児外科学会の論文
1981-12-20

Atrioventricular Discordance を伴う心奇型の手術,遠隔成績と残遺病変

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