Takao Irisawa

Use of Valve-Retaining Homograft and Heterograft Patch for Reconstruction of Right Ventricular Outflow Tract: Clinical Experience in Tetralogy of Fallot

Abstract Thirteen patients with severe tetralogy of Fallot underwent reconstruction for hypoplastic pulmonary artery and diffuse tubular outflow tract obstruction using a preserved homograft or heterograft patch with single or double cusps. The early and late results with our valve-retaining patch provide encouragement for the further application of this method to patients having extremely hypoplastic right ventricular outflow tracts. Pulmonic grafts appear to be preferable to aortic grafts, although further evaluation of these pulmonary homografts and heterografts is needed.

Reviews of corrective surgery in 126 csses of tetralogy of Fallot

One hundred and twenty-six cases , 68 male and 58 female, with tetralogy of Fallot (TF) were operated upon in this period, and 19 patients were less than 5 years of age, 52 being between 6 and 10 years of age, 37 being between 11 and 15 years of age and 18 being older than 16 years of age (Table 1). The Blalock-Taussigs systemic-pulmonary-artery anastomosis had been previously performed in 39 patients who were distributed in all age groups. Almost a l l patients but 12 showed cyanosis at rest and/or i n exercise. Of 126 cases, 17 demonstrated hemoglobin-levels were below 15 g/100 mL, 69 from 15 to 18 g/ 100 ml. and 40 more than 18 g/100 ml., respectively (Table 2). In all patients, a median sternotomy was used. A disc oxygenator was u~ed for the first 75 cases, but since 1969, cardiopulmonary bypass has been accomplished with a disposable bubble oxygenator and roller pumps utilizing the hemodilution technique. Flow rate was usually about 2.2 L/Min/M 2 and mild hypothermia from 33 to 29 degrees centigrade was applied. A transverse or a longitudinal right ventriculotomy was used according to the anatomical findings on t h e right ventricular outflow-tract, described later, and the course of the right coronary artery branches. Infundibular stenosis was removed by division and resection of the hypertrophied muscles and dilatation of the pulmonary annulus with a Tubbs-type dilator. Valvular stenosis was routinely corrected through the ventriculotomy by careful commissurotomy: However, the patients with a small pulmonary annulus and/or a hypoplastic pulmonary trunk received various types of the outflow patch, including the small Teflon fabric patch, the small or large pericardial patch and the valve retaining homoor heterologous pulmonary artery patch 2 (Fig. 1). A large ventricular septal defect was closed with a Teflon fabric patch fixed by interrupted and buttressed mattress-sutures and a specially designed clamp 5 was

Acute Coronary Insufficiency after Aortic Valvular Surgery.

大動脈弁手術203例で, 術後急性冠灌流不全を右冠動脈5例, 左冠動脈2例, 両冠動脈1例の8例 (4%) に経験した. 主症状は, 右冠動脈灌流不全では, 体外循環離脱困難な右心不全3例, 下壁梗塞による左心不全2例, 左冠動脈灌流不全では, 広範梗塞による左心ポンプ不全1例, 心室停止2例であった. 発症直後CABGを追加施行した4症例は全例救命された. Cabrol 手術1例, Piehler 法と弓部置換の同時手術1例の死亡2例では左冠動脈口に縫着した人工血管の血栓閉塞を認めた. 救命6例は術後冠動脈造影で新たな冠動脈病変は認めなかった. 発症原因として, 冠動脈 spasm と拡張障害を伴った左室肥大心における周術期冠予備量の不足が推測された. Piehler 法や Cabrol 手術では冠動脈吻合グラフトの圧迫や吻合部狭窄も示唆された. 救命措置は灌流不全の冠動脈に速やかにCABGを追加する方法が確実であった. 予防対策として適切な手術時間の決定と, 逆行性冠灌流法を含む確実な心筋保護法の応用が考慮された.

Successful Resection of an Ascending Aortic Aneurysm under Cardiopulmonary Bypass Associated with Carotid and Coronary Perfusion

Successful resection of an ascending aortic aneurysm under cardiopulmonary bypass associated with auxiliary carotid and coronary perfusion is reported. The advantages of the cardiopulmonary bypass such as the present method in surgery of aneurysms of the ascending aorta and aortic arch are discussed.

Surgical correction of single atrium.

Three cases of the single atrium (cor triloculare biventricularis) were operated upon successfully, and diagnostic and surgical aspects of this rare malformation were discussed.

The Surgical Treatment of Ventricular Septal Defect with Aortic Insufficiency, with Special Emphasis on Valve Replacement

The surgical treatment in 4 patients with ventricular septal defect associated with aortic insufficiency is described. The closure of ventricular septal defect by itself improved the degree of aortic regurgitation in 2 moderately severe cases. However, aortic insufficiency could not be controlled by the closure in 2 severe cases, and aortic valve replacement was performed with a Starr-Edwards aortic prosthesis with one success. Our concepts regarding indication for operation and principle of operative procedure were presented.