多次手術による I-A 型大動脈弓離断症の1治験例

概要

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A successful surgical treatment of a newborn with IAA and VSD by staged operation is presented. The patient was diagnosed as IAA associated with VSD on the 15th day and aortic arch reconstruction by Blalock-Park procedure and pulmonary artery banding were carried out on emergency bases on the day of diagnosis. The postoperative recovery was uneventful and he had satisfactory physical development. Cardiac catheterization and angiography at 1 year and 9 months after the initial operation revealed stenosis at the site of aortic reconstruction with a pressure gradient of 65 mmHg. Aortic stenosis was releaved by patch aortoplasty through lateral thoracotomy. At the age of 2 years and 3 months, open heart definitive repair (patch closure of VSD, debanding and patch plasty of the pulmonary artery) was performed successfully. Postoperative angiography demonstrated satisfactory correction of both aorta and pulmonary artery. We conclude that : 1) Aortic arch reconstruction and pulmonary artery banding can be safely and reliably performed even in a critically ill neonate with IAA and VSD, 2 ) Staged definitive intracardiac repair can be done safely without any incremental risk factors.
日本小児外科学会の論文
1989-12-20