肺動脈狭窄症の手術適応及び手術手技選択に関する検討

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From 1965 to 1985, pulmonary stenosis with intact ventricular septum (PS with IVS) was diagnosed in 176 patients by cardiac catheterization at the Meijo Hospital. Sixty-four cases underwent corrective surgery (55 valvotomy and muscle resection, 4 simple outflow patch, 5 transannular monocusp outflow patch). Three had pulmonary valvular dysplasia. There were 3 hospstal death. Preoperative recatheterization showed progressive high systolic right ventricular pressure (PRV) in all case over 80mmHg of PRV and in some of 65-80mmg at the first catheterization. Preoperative PRV correlated well to pulmonary valve area measured intraoperatively (r=-0.455). The higher preoperative PRV cases showed the higher postoperative PRV. Eight cases without outflow patch, who were over 3-year-old and had high PRV over 80mmHg, had persistent high PRV over 80mmHg at one month after operation. The intraoperative peak systolic right ventricular pressure versus systemic arterial pressure ratio (PRV/PSYS) (x) well correlated to postoperative PRV/PSYS (y) (r=0.834, y=0.16+0.50x). It is concluded that (1) PRV over 80mmHg is anindication for operation, and 65-80mmHg may be followed conservatively with caution, (2) the elder patient with higher PRV requires an outflow patch, especially over 5-year-old and 150mmHg, (3) the transannular monocusp outflow patch is useful for pulmonary valvular dysplasia, (4) prediction of prognosis and decision of surgical technique are suggested by measuring of the intraoperative PRV/PSYS, (5) we must cautiously decide the surgical indication and technique for PS, not only preoperatively, but also during operation.
日本小児外科学会の論文
1988-06-20

肺動脈狭窄症の手術適応及び手術手技選択に関する検討

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