心室中隔欠損症に対する再手術 30 例の検討

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In thirty cases, re-closure of VSD was done at our clinic. The purpose of this report is to evaluate the re-closure of VSD for improvement of the cardiac status with minor surgical risk. Re-closure of VSD was undertaken in the period from 5 hours to 18 years after the first operation (mean 4 years and 7 months). The patients were 17 males and 13 females. According to the classification of VSD by Kirklin, the original type of residual VSD were 7 in type 1, 17 in type 11 and 4 in type 111. One showed complete conus defect and another one had multiple VSD. The operative finding at the secondary closure of VSD showed that the primary cause of the development of leakage in type 1 was due to tissure disruption at the site of suture closure without patch. In type 11 VSD, the main location of disruption of the patch was the annulus of the aortic valve in 5 and at the inferior margin of VSD in 5. In residual VSDs in type 111, the inferior margin was identified at the major point of leakage. Operative procedure for re-closure of VSD was closure of VSD with a patch in 15 and suture closure without a patch in 13. One case needed concomitant tricuspid valve replacement with the Hancock prothesis and permanent pacemaker implantation and another one tricuspid annuloplasty beside re-closure of VSD using the Carpentier's ring to control a significant tricuspid regurgitation. The operative results showed that there were one table death (mortality rate 3.3%) and 25 cases in satisfactory with complete closure of VSD (83.3%). However, two cases showed minor residual VSD even after re-closure of VSD. One remained minor aortic regurgitation and the other needed strict medical treatment for chronic congestive heart failure due to large left to right shunt. Postoperative EKG findings in 27 of 30 cases were with complete RBBB, three of which had LAD as well. These results suggested that re-closure of VSD can be done with minor surgical risk in order to improve to patient condition.
日本小児外科学会の論文

心室中隔欠損症に対する再手術 30 例の検討

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