ファロー四徴症根治手術後の肺動脈弁閉鎖不全に関する研究
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概要
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Recently, the result of total correction of tetralogy of Fallot has been satisfactory gradually, but in cases who used a large outflow patch, operative results were not so good. Post-operative pulmonary valvular insufficiency (PI) is one problem that reduced operative results in such a case, suspect. In ten years, from Sep. 1966 to Aug. 1976, 73 cases after total correction of tetralogy of Fallot were examined hemodynamically by the right side heart catheterization at Kobe University Hospital, 2nd Dep. of Surgery. They were classified to 5 groups by the method of the reconstruction of the right ventricular outflow tract, and further post-operative PI classified to 3 grades, severe, moderate and mild, from intracardiac pressure. Following results were obtained. 1) In I group, infundibulectomy only, post-operative PI occured not so frequently, except in cases complicated pulmonary hypertension. There were no hemodynamical problems in this group. 2) In II group, infundibulectomy and pulmonary valvulotomy, frequency of PI is 77%, but severe PI was none. No bad influency on surgical results in this group. 3) In III group, infundibulectomy and pulmonary annular patch (no cusps), PI occured in all cases, but everyone was under moderate PI and successed. 4) In IV group, infundibulectomy and used long-large outflow patch (no cusps) .conduited from the right ventricular outflow tract to the pulmonary artery, 1/3 cases dead by LOS due to severe PI. Most of survival cases was over moderate PI and since some cases remained severe PI and required very intensive cares. 5) In V group, infundibulectomy and used mono cusp-beared outflow patch, no severe PI occured and everyone was under moderate PI. The cusp for prevention of regurgitation was most effective for preservation of the right side cardiac function, and acted its function during especially early post-operative days. 6) As mentioned above, in the total correction of tetralogy of Fallot, if necessary of the outflow patch, it might be used smaller one as possible. In cases of need of large outflow patch, it might be used cusp-beared patches.
- 神戸大学の論文