Right ventricular function after extracardiac conduit repair for tetralogy of Fallot A comparison among surgical approaches.:A Comparison among Surgical Approaches

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概要

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• Right ventricular volume measurements and hemodynamic studies were performed in 20 patients after total correction of tetralogy of Fallot. There were 6 patients with an extracardiac conduit and Hancock xenograft (G-1), 8 with an outflow tract patch (G-2) and 6 without or with a minimal right ventriculotomy and repair of pulmonary valve (G-3). The age at the time of operation was over 3 years in each patient and averaged 5±2 (mean±SD) years. Right ventricular systolic pressure averaged 81±22, 55±22 and 58±30mmHg in G-1, G-2 and G-3, respectively. Right ventriculography showed no contraction of the right ventricular free wall at the anastomosis to the conduit and poor contraction around the anastomosis in G-1. The right ventricular enddiastolic volume index (RVEDVI) was 114±31, 155±57 and 115±28ml/m2 in G-1, G-2 and G-3, respectively. The right ventricular ejection fraction (RVEF) was 0.42±0.11 in G-1, 0.53±0.04 in G-2 (p<0.05, vs G-1) and 0.57±0.04 in G-3 (p<0.02, vs G-1). Pulmonary regurgitation was evident in 17 patients, and RVEDVI correlated well with degrees of pulmonary incompetence.Fourteen patients in G-2 and G-3 were divided into G-A and G-B to evaluate right ventricular function with or without pressure overloading of the right ventricle. G-A consisted of 7 patients with a right ventricular systolic pressure of more than 50mmHg (74±26) and G-B of 7 patients with a value less than 50mmHg (39±4). There was no difference in RVEDVI and RVEF between G-A and G-B. RVEF was significantly lower in G-1 than G-A (p<0.02) and G-B (p<0.05).These results suggested that an extracardiac conduit with Hancock xenograft reduced the contraction of the right ventricular free wall and induced a depressed right ventricular pump function in patients with a high right ventricular pressure.

• International Heart Journal刊行会の論文

著者

• Hirose Hajime

  First Department Of Surgery Gifu University School Of Medicine

• Yagihara Toshikatsu

  First Department of Srugry, Osaka University Medical School

• Nakano Susumu

  First Department Of Surgery Osaka University Medical School

• Kawashima Yasunaru

  First Department Of Surgery And Department Of Physiological Chemistry Osaka University Medical Schoo

• Morimoto Shizuo

  Department Of Radiology Osaka University Medical School

• Shimazaki Yasuhisa

  First Department Of Surgery Osaka University Medical School

• Ogawa Minoru

  Department Of Pediatrics Osaka University

• Nakano Susumu

  First Department of Surgery, Osaka University Medical School

• SHIMAZAKI Yasuhisa

  First Department of Surgery, Osaka University Medical School

• YAGIHARA Toshikatsu

  First Department of Surgery, Osaka University Medical School

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