Sakae Asada

Surgical treatment of tricuspid insufficiency in patients undergoing mitral valve replacement

During the past eight years, 46 of the 106 patients who underwent mitral valve replacement were associated with tricuspid insufficiency. No surgical correction was performed (14 cases) in cases of slight tricuspid insufficiency. Tricuspid annuloplasty (11 cases) or valve replacement (21 cases) was employed according to the severity of insufficiency. In the non-repair group, the mortality rate was fairly low (21 per cent), but the postoperative status was the least satisfactory by the NYHA classification. Tricuspid insufficiency was significantly reduced only in two of these 14 cases after the mitral valve replacement. In the tricuspid annuloplasty group, although the technique of tricuspid annuloplasty did not always correct insufficiency completely, only one patient died of residual insufficiency. The cardiac output measured with Minnesota Impedance Cardiograph increased postoperatively in proportion to stress in this group. In the tricuspid valve replacement group, cardiac catheterization studies revealed hemodynamic improvement at rest in all, but cardiac output during exercise remained unchanged or decreased in some cases. Now we consider that tricuspid insufficiency with advanced mitral valve disease, even of a slight degree, should be surgically treated and that annuloplasty has more obvious hemodynamic benefits than valve replacement.

Significance of the pulmonary vascular bed in total correction of tetralogy of fallot

In patients with tetralogy of Fallot, those with intrapulmonary pulmonary arterial stenosis (IPPS) diagnosed by angiocardiographic measurement and pulmonary scintiscanning seem to be poor candidates for one stage total correction. The results obtained in the present study indicate the significance of developmental state of pulmonary vascular bed in establishing indication for total correction of tetralogy of Fallot. In view of the improvement of IPPS following the shunt operation, second-stage total correction after the Blalock shunt is recommended in those with IPPS.

Severe Jaundice After Open-Heart Surgery

57歳男子および39歳女子で心臓連合弁膜症・多弁置換術術直後に発生した重症黄疸の2剖検例を報告した.黄疸は術後第1日目に発生し,術後12日および32日目に死亡した.血清総ビリルビン値は最高53.25mg/dlおよび34.21mg/dlで,常に直接型ビリルビンが高くS-GOT,GPT,血清アルカリフォスファターゼはほぼ正常値を示した.1例では術前既に血清総ビリルビン値がやや高く(1.25mg/dl),慢性非活動性肝炎の素地の上に細胆管炎性肝炎が発生したと考えられる組織像であり,他の1例では術前血清総ビリルビン値は正常で,組織学的に肝内胆汁うっ滞が軽度にみられ,慢性うっ血がみられたのみであった.