複雑心奇形に対する新生児期非開心姑息術の治療成績

概要

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In order to assess the operative results of closed palliative operation for complex cardiac anomalies in the neonatal period, we reviewed 39 neonates operated on from January 1980 to June 1989. Among 39 neonates, there were 11 cases with pulmonary atresia or critical pulmonary stenosis (PPA), 5 with interrupted aortic arch (IAA), 8 with coarctation of the aorta (CoA), one with hypoplastic left heart syndrome (HLHS), 5 with other defects with increased pulmonary blood flow, and 9 with other defects with decreased pulmonary blood flow. The number of operative deaths were 9 (23%). Among 9 deaths, there were 3 cases with PPA, one with IAA, 4 with CoA, and one with HLHS. Although operative results of shunt operation for defects with decreased pulmonary blood flow was satisfactory, additional shunt operation was needed in half of patients. Results of Brock procedure via right ventricle for PPA, Blalock-Park procedure for IAA (A type), and pulmonary arterial banding for defects with increased pulmonary blood flow were satisfactory. Especially, the growth of the right ventricle after Brock procedure for PPA was excellent in patients whose preoperative right ventricular end-diastolic volume was more than 30% above normal. The pressure gradient at the anastomosis site after Blalock-Park procedure for IAA was negligible, in cases with subclavian artery greater than 3.0mm in diameter before the operation.
日本小児外科学会の論文
1990-10-20