Natural and unnatural histories of the pulmonary vascular circulation with a ventricular septal defect (VSD)

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概要

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• A total of 482 preoperative and 63 postoperative cases with VSD were catheterized to analyze their hemodynamic and pulmonary vascular status. Two different clinical courses are discussed depending upon the age of the patient. Either the Rp/Rs ratio can be maintained within the normal range or otherwise can be progressively increased. The Rp/Rs in the postoperative pe-riod tends to decrease in most cases. However a higher preoperative Rp/Rs and an older age at surgry, leads to smaller decrements in the postoperative Rp/Rs. In 17 cases with a preoperative Rp/Rs greater than 0.7, 5 fatalities and 12 survivors were found. There were 3 patients with "Eisenmenger com-plex" among the survivors. Pure oxygen was inhaled to examine the pulmonary vascular responsiveness. The patients with good oxygen responses before the operation had greater decrements in the postoperative Rp/Rs. 25 fatalities were found pre-and postoperatively. 9 patients, whose ages were less than 1 year were among 21 catheterized cases with Qp/Qs greater than the 12 cases which were older than 1 year. However, the Rp/Rs under 1 year of age was signifi cantly less than that over 1 year of age. 9 fatalities in patients under 1 year of age had significantly higher PaCO<SUB>2</SUB> levels than the survivors who were also under 1 year of age. It is concluded that infants who suffer from respiratory failure must be treated with surgical intervention. Corrective surgery may also be planned for other cases, when the preoperative Rp/Rs is greater than 0.9, except those who are older than 5 years and have failed to respond to oxygen and/or Tolazolin.

著者

• Yokochi Kazuoki

  Department Of Pediatrics And Child Health Kurume University School Of Medicine

• Koga Michihiro

  Department Of 2nd Surgery Kurume University School Of Medicine

• Eto Yoshiharu

  Department of Pediatrics, Kurume University School of Medicine

• Eto Yoshiharu

  Department Of Pediatrics Kurume University School Of Medicine

• Kato Hirohisa

  Department Of Cardiovascular Medicine National Center For Child Health And Development

• Toshima Hironori

  Department Of Cardiology Kurume University Medical Center

• UTSU FUMIHIKO

  Department of Cardiovascular Research Institute, Kurume University School of Medicine

• MIKAZIMA TAKATOSHI

  Department of Pediatrics, Kurume University School of Medicine

• YOKOCHI KAZUOKI

  Department of Pediatrics and Cardiac Division, Kurume University School of Medicine

• YOKOCHI KAZUOKI

  Department of Pediatrics, Kurume University School of Medicine

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