12ヵ月未満乳児開心術の補助手段

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The mortality of open heart surgery for infants under the age of 12 months remained higher than it in the older-age group. The weakness and premature function of organs were considered as one of the reasons. If so, the surgical technique should be chosen very carefully for such infants. Then, we reviewed surgical techniques in 116 open heart cases under the age of 12 months, operated upon from Jan. 1977 to Dec. 1982, in The Heart Institute Japan, Tokyo Women's Medical College. A various techniques, such as profound hypothermia and circulatory arrest induced with combined surface and core cooling, moderate hypothemia with bypass, with or without aortic cross-clamping, and staged operation were discussed. The results suggested that various techniques suitable for different procedures should be chosen for improvement of surgical mortality in sick infants. Consequently, the most recent protocols for infant open heart surgery were summarized as the followings: (1) In a case of VSD with PH, closure is made under moderate hypothermia induced with bypass, and aortic cross-clamping with Young solution.(2) In a case of TAPVC, intracardiac repair is performed under moderate hypothermia induced with bypass, and no aortic cross clamping. (3) In a case of d-TGA's, atrial switch procedure is made under profound hypothermia induced witch combined surface and core cooling and circulatory arrest. (4) In a case of CoA, or Interrupted aortic arch, two-staged operations were preferable with lower mortality. In the first stage, reconstruction of aortic root and pulmonary banding through left thoracotomy, are scheduled, and closure of VSD around the age of two years, in the second stage.
日本小児外科学会の論文
1984-08-20

12ヵ月未満乳児開心術の補助手段

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